New CRPS Adult guidelines ~ some thoughts

The 2nd edition of the ‘CRPS in adults’ guidelines have been released on the Royal College of Physicians website. You can click here for a direct link to the page where they are available for downloading.

This is important for several reasons. Firstly because CRPS (complex regional pain syndrome) is one of many painful conditions that is poorly understood by both society at large and the healthcare community. Secondly, updates should be regular because our understanding is always advancing, in particular when it comes to pain. One of the primary features of CRPS is the pain, which results in enormous suffering via the effects. The guidelines point out that even when limb signs (see Budapest Criteria) abate, if the pain persists, CRPS can still be considered active. In these cases, where the limb signs were previously existent, CRPS can be diagnosed in its NOS (not otherwise specified) form.

“Complex regional pain syndrome (CRPS) is a debilitating, painful condition in a limb, associated with sensory, motor, autonomic, skin and bone abnormalities” (Veldman et al., 1993)

The Budapest Criteria were an important step in classifying CRPS, when the condition can be diagnosed incorrectly on the basis of sensitivity and not the necessary signs and symptoms. A number of people will be told that they ‘have’ CRPS when in fact they do not, starting a quest for answers and treatment, but of course barking up the wrong tree. One of the major issues in this situation is that this often leads to an internet search, which highlights the many stories that would do nothing except heighten fear. Whilst fear is a normal emotion, it is also responsible for holding people back, as well as driving behaviours that are not in line with success. Overcoming and using fear, rather than fear using the person, is vital in the process of moving forward.

Screen Shot 2018-07-25 at 16.26.14
Budapest Criteria (Harden et al. 2007)

The updated document is packed with the latest knowledge and statistics. There are algorithms to guide therapists and clinicians, and lists of therapeutic interventions and rehabilitation techniques. For all healthcare professionals working in ‘musculoskeletal care’, this is a must read. It forms a good foundation from where the CRPS literature can be explored.

Beyond this, it is necessary to look at the pain literature that includes the latest thinking, which is a blend of neuroscience and philosophy. At the peak of insight, it is common language to talk about the whole person, that the person experiences pain and that the brain is an inference machine making a best guess. All of these concepts are richly bound and grounded in science but are far from the mainstream. That is the problem. The mainstream remains bound tightly to the biomedical model, which has a role in eliminating disease and pathology for example, but must hand over to a comprehensive model that supports and encourages the necessary understanding, empowerment, independence and actions that get results.

It is for this reason that some years ago I began to blend practical strengths-based coaching with pain and perceptual science, simply aiming to get the best out of each individual. Most people do not reach their potential, largely held back by fear and misunderstanding. There is a very good reason why Understand Pain is called Understand Pain. The problem of any condition or pain exists when we have no understanding and no solutions. Whilst pain is always unpleasant, when understood together with a toolbox of practices and strategies, it is no longer a problem per se. This is a significant step forward as the person changes their approach and relationship with the condition and how it emerges in them. To achieve this requires ‘know-how’ and self-coaching, using new scripts or inner dialogues that drive new actions that are in line with a clear reference point: the person’s picture of success. Without a direction, we drift. Consider the announcement on an aeroplane when the captain speaks over the tannoy, saying that we will be taking off, but the destination is unknown. We need a picture, or a prize, and we need principles to follow to get results using our strengths and successful styles. We all have those.

CRPS remains a challenging condition for the sufferer and those close-by. However, there is massive optimism as we gather momentum behind approaches that get the best of people. It is not just about exercising. It is about a complete approach that addresses all the dimensions of pain and suffering in their unified form, all the influences and how we can actively infer something new and better in our thinking and actions. Gaining momentum is key, as practices are interwoven into each day, integrated and implemented by the individual who feels gathering control and empowerment towards their picture of success.

On we go, together.

RS — more here

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