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CRPS treatment

Complex regional pain syndrome is treated here with a rehabilitation-led plan started as early as possible, supported by medication review and, in selected cases, sympathetic nerve blocks, supervised infusion therapy or neuromodulation. Dr Chris Martin's dual training in pain and rehabilitation medicine suits a condition where both matter.

CRPS is a condition in which pain, swelling, colour and temperature change and loss of movement persist and intensify in a limb after an injury or operation, out of proportion to the original event. It is frightening, often diagnosed late, and responds best to treatment that starts early and keeps the limb moving. Because the condition involves both the nervous system and the limb's function, it sits at the junction of pain medicine and rehabilitation medicine — the two disciplines in which Dr Martin holds fellowships.

Early diagnosis

CRPS is diagnosed clinically against internationally accepted criteria, after other causes — infection, nerve compression, vascular problems — have been considered. No scan or blood test confirms it. Because early treatment matters, a GP who suspects CRPS is encouraged to refer promptly rather than wait for certainty; the practice prioritises these referrals. See Complex regional pain syndrome for how the condition presents.

Rehabilitation-led treatment

The core of CRPS treatment is a graded program that restores the limb's use: desensitisation of the painful skin, graded motor imagery and mirror therapy where appropriate, progressive loading and functional tasks, and attention to the fear of movement that the condition understandably produces. Dr Martin designs this program and works with hand therapists, physiotherapists and occupational therapists experienced in CRPS. The aim is to move the limb back into normal use in steps small enough to be tolerated.

Medication review

Nerve pain, poor sleep and low mood tend to arrive together in CRPS and are addressed together. Medication review looks at what is helping, what is not, and what is making rehabilitation harder, and sets out a plan with your GP.

Sympathetic nerve blocks

In some people the sympathetic nervous system contributes to the pain, and a block of the sympathetic chain supplying the limb — at the neck for the arm, in the lumbar spine for the leg — can reduce pain for a period. The evidence for lasting benefit is limited, and blocks are used selectively, usually to create a window in which rehabilitation can advance rather than as a treatment in themselves. They are performed under X-ray guidance as a day procedure.

Infusion therapy and neuromodulation

For a small number of people with severe CRPS that has not responded to the above, supervised infusion therapy as an inpatient is considered, and for persistent limb pain despite full treatment, spinal cord stimulation has reasonable evidence in CRPS specifically. Both follow full assessment and are not first-line options.

What to expect

CRPS improves substantially in many people, particularly where treatment starts within the first months. In others it becomes a long-term condition that is managed rather than resolved, and the goal becomes a limb that works and a life that is not organised around the pain. Realistic expectations are set at the first consultation and reviewed as treatment proceeds.

Risks

Whilst pain procedures are generally safe and well tolerated, all procedures carry risks. The specific risks relevant to you and your procedure will be discussed with you, and written information provided, before you decide to proceed.

Common questions

Is CRPS curable?

Many people improve substantially, especially when active treatment starts early, and some recover fully. For others it becomes a long-term condition managed with a plan. Early referral gives the best chance of a good outcome.

Should I rest the limb or use it?

Use it, within a graded plan. Rest and protection, understandable as they are, tend to worsen CRPS. The rehabilitation program is designed to restore use in steps small enough to tolerate.

Why see a pain specialist rather than a surgeon?

CRPS is not a surgical problem, and operating on a limb with active CRPS can worsen it. It is managed by pain and rehabilitation medicine, with surgery considered only for a specific, separate reason and with precautions.

Do nerve blocks cure CRPS?

No. Sympathetic blocks reduce pain for a period in some people and are used to make rehabilitation possible. They are not a stand-alone treatment.

Is CRPS recognised for motor vehicle and workers compensation claims?

Yes. It is a recognised diagnosis, and the practice provides the assessment and reporting these schemes require.