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HPC | Hertfordshire Pain Consultants

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  • I wanted to write a letter to you because I'm so grateful to you and your team at the pain management clinc. After spending over 15 years with the most horrendous headaches and seeing dozens of different doctors and therapists finally you have managed to get them under control. Thanks you for taking the time to genuinely listen to me and my problems. Much appreciated.

    K. R
    Hertfordshire
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Content

Complex Regional Pain Syndrome

A nerve related condition that can leave patients with permanent disablility.

This chronic pain condition is a nerve related pain disorder that occurs after trauma (even minor) and is confined to a limb (leg, arm) , associated with a number of other symptoms including swelling, sweating, colour change, temperature differences, nail and skin differences in the affected limb.

The nerves become sensitised leading to a number of changes in which the nerve function is affected compromising the ability of the nerve to sense light touch, pain, control of blood vessels, temperature.

Diagnosis

The diagnosis is purely clinical based upon symptoms on questioning and examination finding.  The criteria is called the Budapest criteria.  In addition there must be exclusion of other conditions such as infections, venous thrombosis and vascular disorders than can present in the same way.

Symptoms
  • Nerve pain
  • Skin sensitivity
  • Swelling , Sweating
  • Colour and temperature changes
  • Muscle weakness, Muscle loss, Muscle rigidity
Investigations
  • Blood tests to exclude infections
  • X-ray investigations may show osteoporosis but this is not diagnostic
  • Triple phase bone scan

Treatments

Without urgent and aggressive treatment patients can be left with a chronically painful limb with limited movement. 

Physical therapy regimes play a hugely important part in returning the limb to normal function not only in the way it senses but also in the way the limb moves.  Therapy treatments may involve desensitisation, mirror box therapy, graded motor imagery and graded rehabilitation programme.

Medications such as nerve pain killers and strong morphine based medications can be useful under direction of the pain specialist.

Injection treatments

Sympathetic nerve blocks such as stellate ganglion blocks and lumbar sympathectomy

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