Signs and Symptoms

Based on the Budapest Criteria

1. Significant pain (normally in a distal limb) out of proportion to injury/event

2. No other diagnosis more likely.

3. With symptoms and sign including (but not requiring all of):

• Pain on slightest touch or significant pain to light pin prick (allodynia or hyperalgesia)
• Colour changes, swelling, unilateral hot or cold changes, unilateral changes in sweating, trophic changes in the area, motor loss

• Reassure patient and encourage gentle movement and touching
• Advise the patient to start on Vitamin C 500mg once a day for two months
• Start anti-neuropathic agent appropriate to patient as per neuropathic pain guidelines
• Use simple analgesia and weak opioids in conjunction with vitamin C as appropriate
• Act as overall conductor of specialist services: If onward referral required, options may include: rheumatology, neurology, neurosurgery, orthopaedics, general medicine
• Refer to physiotherapy as 'probable CRPS for evaluation and encouragement in moving and touching' (avoiding limb neglect)
• Refer to Pain clinic 'Urgent CRPS suspected'
• Refer to appropriate specialist Orthopaedics/plastics/Rheumatology if diagnostic uncertainty
• Refer to Pain clinic 'Urgent CRPS suspected'
• Refer to Long Term Conditions Self Management Programme for patient support with any long-term physical or low level mental health condition.

Referral Criteria

• Excluded appropriate other pathology

Based on the Budapest Criteria

• Significant pain (normally in a distal limb) out of proportion to injury/event
• No other diagnosis more likely
• With symptoms and sign including (but not requiring all of):
  • Pain on slightest touch or significant pain to light pin prick (allodynia or hyperalgesia)
  • Colour changes, swelling, unilateral hot or cold changes, unilateral changes in sweating, trophic changes in the area, motor loss

Referral Instructions

e-Referral Service Selection

• Specialty:Pain Management
• Clinic Type: Pain Management
• Service: DRSS-Western-Pain Management-Devon ICB-15N

Refer to Long Term Conditions Self-Management Programme

• Email: self-management@improvinglivesplymouth.org.uk
• Phone: 01752 201892
• Include a contact email address

Referral Form

DRSS Referral form

GP Information

Complex regional pain syndrome in adults a concise guide

Improving Lives Plymouth - Long Term Conditions Self-Management Programme

Patient Information

Versus Arthritis – Complex regional pain syndrome (CRPS)

NHS Choices – Complex regional pain syndrome

Evidence

Complex regional pain syndrome in adults – full guidance

Pathway Group

This guideline has been signed off by the Pain management team on behalf of NHS Devon.

Publication date: February 2017
Updated: October 2018