The Royal National Hospital for Rheumatic Diseases

Complex Regional Pain Syndrome (CRPS) Service

Welcome to the Complex Regional Pain Syndrome (CRPS) service.   We are a national specialist service funded by NHS England, offering intensive rehabilitation for adults with CRPS.  The service was set up in 1999 and is one of the few in the UK dedicated to the treatment of CRPS, providing outpatient and inpatient care.

The term CRPS is used to describe a collection of symptoms where pain in a limb is the major problem.  Pain may start for no apparent reason or following injury to the limb (such as a fracture).  Normally the pain would settle as the injury heals, but in CRPS the intense pain continues and spreads beyond the original site of the injury.  Other features of CRPS include altered temperature and colour changes, as well as impaired movement of the painful limb.  There is no specific test to diagnose CRPS – doctors need to rule out other conditions first, so this may mean that you have already seen lots of health professionals before receiving a diagnosis.

We are a multi-disciplinary team of healthcare professionals who have extensive experience in treating CRPS.  These include doctors, nurses, physiotherapists, occupational therapists and psychologists.  We provide diagnosis and non-medical management of CRPS, and we also offer a two week specialist rehabilitation programme.  The aim is to improve your function and quality of life, as well as supporting you to self-manage your condition in the long-term.

If you have a suspected or confirmed diagnosis of CRPS, then your GP or pain specialist can refer you to our service.  Once a referral is accepted, you will be assessed by a Pain Consultant and a Consultant Nurse at our specialist centre in Bath.  These outpatient assessments cover diagnosis and a discussion of the most appropriate options for you.  You may be provided with recommendations for new therapies or medications, or given advice about specific exercises or techniques to practice. 

If appropriate, you will be invited to return for a second series of outpatient appointments – these include appointments with a physiotherapist or occupational therapist, a psychologist, and a thermography scan to measure the temperature of your affected limb.  These appointments will assess your progress with any initial recommendations and further discuss whether our two week inpatient rehabilitation programme is appropriate for you.

The programme includes physiotherapy, occupational therapy and hydrotherapy.  It is mainly a group-based programme, but you will work regularly with the therapists on an individual basis towards achieving agreed goals as part of individually tailored rehabilitation.  Ongoing support and expertise is also offered following the inpatient programme.  If the rehabilitation programme is not appropriate for you, then we will refer you back to your local GP and may provide recommendations for local physiotherapy, occupational therapy or psychology support.

A podcast about the CRPS programme has been produced by the charity Pain Concern for their internet radio service ‘Airing Pain’.  This first aired in October 2017 and can be accessed below:

A former patient of our service has recently appeared on a BBC Wiltshire radio broadcast and you can view the clip below (source www.bbc.co.uk, clip from Ben Prater, 15th February 2018):

Complex Cancer Late Effects Service

We are the Complex Cancer Late Effects Rehabilitation Service, which provides treatment for two different groups of patients:  Breast Radiation Injury Rehabilitation (BRIRS) and Complex Cancer Late Effects Rehabilitation (CCLERS).  Both use the same pathway of assessment clinic, rehabilitation programme and follow up.  Both services are funded by NHS England.

The Breast Radiation Injury Rehabilitation Service was set up in 2012 to help patients who had sustained brachial plexus injury.  It is a rare consequence of radiotherapy treatment for breast cancer.  This type of injury was historically more common and is usually associated with now outdated radiotherapy practices.  Patients may present with a complex range of symptoms.  These can include:  severe and constant pain in the affected arm, limited function of arm and hand, lymphoedema and skin changes of the arm on the affected side.  Symptoms of brachial plexus injury may arise several years after treatment.

Building on the success of BRIRS, we have now developed CCLERS.  The Complex Cancer Late Effects Rehabilitation Service is a specialist rehabilitation service for people experiencing unresolved persistent pain and reduced physical function due to the consequences of treatment for cancer (any tumour site).  The criteria for each service is shown on our ‘referral and pathway process’ page.

After we have received a referral from your health professional, you will have a telephone assessment with our nurse specialist.  If you meet the criteria, you will be invited to attend a two day clinic.  This clinic consists of individual consultations with specialists from pain, psychology, physiotherapy and occupational therapy.  The clinic also offers rehabilitation in a group setting, which addresses topics such as exercise and coping strategies.

If appropriate, you will be invited to our two week inpatient rehabilitation programme.  This will give you access to specialist physiotherapy (including hydrotherapy), occupational therapy, psychology and education.  Our aim is to improve your function and quality of life, as well as supporting you to self-manage your condition in the long-term.