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Exclude alternative or additional diagnoses including:
The diagnosis is clinical and may be difficult, particularly in the early stages of the syndrome where there may be little, if any, objective evidence of a problem. The Royal College of Physicians recommends that doctors and other trained therapists use the 'Budapest criteria' to make a diagnosis.
EARLY ACTION FOR ALL
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All patients with a diagnosis of CRPS using the Budapest Criteria should be referred, or encouraged to self-refer, to Core Physiotherapy.
Patients with a diagnosis of CRPS using the Budapest Criteria and who have failed to respond to appropriate therapy (within 4 weeks) should be referred to Pain Management.
Chronic Pain MDT provided by GHNHSFT includes Physiotherapy, Occupational Therapy, Nursing, Psychology and Consultants in Pain Medicine. Services include assessment of pain, education, advice and reassurance. Specialist Nurse can provide support for medication reduction if needed. Pain self-management interventions including Pain Management Programmes, Mindfulness Courses and 1:1 CBT and specialist exercise interventions available.
Some people with particularly complex pain presentations may benefit from referral to the tertiary pain management service at the Bath Centre for Pain Services www.bathcentreforpainservices.nhs.uk. In order to access funding from NHS England referrals must be sent from secondary care services demonstrating that all local options have been exhausted or are inappropriate.
The long-term management of treatment-resistant CRPS should be shared between the primary care clinician, Physiotherapy team and chronic pain service and, where appropriate, specialist rehabilitation services.
Rehabilitation for patients with chronic CRPS: (defined as patients who have failed to respond to or progress with previous physiotherapy/hand therapy)