No More Painsplaining! Effective Education for Complex Regional Pain Syndrome

For physios, understanding Complex Regional Pain Syndrome (CRPS) goes beyond recognising its classic signs.

While this is the first (and very important) step, the really important role of the physio is about communicating effectively with patients, supporting them through rehabilitation, and empowering them to manage their symptoms.

This blog explores some foundational elements of education interventions for CRPS, what they should include, and how clinicians can incorporate these principles into practice.

If you want to know exactly how an expert CRPS physio educates his patients, watch Marc Piqué Batalla’s full Masterclass here.

What is CRPS?

It’s considered a chronic pain condition that most often develops after trauma or surgery, though it doesn’t always have a clear trigger.

Typically, the symptoms affect one limb and the patient may experience swelling, changes in colour, temperature fluctuations, and even alterations in hair or nail growth. What makes CRPS particularly complex is that there is no known cure and no standardised clinical pathways for treatment. Consequently, an interdisciplinary approach is considered the gold standard, and treatment should include a combination of physiotherapy/rehabilitation, psychology, pain management, and patient education.

An important diagnostic criterion is that no other condition can fully explain the patient’s symptoms – which perhaps reflects how little we really know about the condition! Type 1 CRPS occurs without an identifiable nerve injury, while Type 2 occurs with a known nerve injury.

How common is it?

Prevalence estimates are of course limited, but at the moment the data indicates that up to 30% of individuals are diagnosed with CRPS following fracture or surgery, though transient symptoms are relatively common and they often reduce during the first year. Still, around 30% of these patients develop persistent symptoms requiring long-term management.

Aims of education

Education often forms the foundation for effective management of CRPS, so it’s important that we get it right! Physios are frequently the ones leading this effort, so understanding the elements of effective education, and how to avoid ‘painsplaining’ is integral to our treatment approach.

Education for patients with CRPS has several important goals:

1. Provide understanding and insight into the condition, helping patients recognise aggravating and easing factors that influence symptoms.
2. Raise awareness of elements that can influence CRPS, such as over-activity, stress, or unhelpful behaviours.
3. Promote active engagement with rehabilitation, encouraging patients to participate meaningfully in their recovery and providing advice to support physical activity.
4. Challenge unhelpful beliefs, attitudes, and behaviours, supporting realistic expectations for recovery and self-management.

Principles of education

Delivering effective education is about more than giving information; learning is an active process.

In CRPS, several principles should guide how physiotherapists educate patients. For example, knowledge is constructed actively, meaning patients make sense of new information in the context of their prior experiences. Learning is also enhanced when it occurs in a collaborative, social environment, and when patients see education as part of a bigger picture rather than isolated facts. See Marc explain the principles of education for CRPS in the below clip from his Masterclass:

One key element

A central theme of effective education – and ultimately, effective CRPS management – is helping patients develop a sense of control over their condition, see Marc explain how we can help patients achieve this in the below video from his Masterclass:

What education should include

So how can physiotherapists help patients gain control through information and support? Luckily, an evidence-based consensus from CRPS experts and patients with lived experience highlights several key areas to focus on (1):

• Implement early interventions if CRPS is suspected (including advice to seek multi-disciplinary care).
• What is CRPS? Explain it’s a real, recognised condition, not “all in the patient’s head.”
• Explain pain persistence and flares: Help patients understand what may trigger symptoms.
• Medication: Be clear about the limitations of current drugs.
• Diagnosis, prognosis, and expectations: Persistent CRPS is long-term, not progressive or fatal, and can be managed, though there is no known cure.
• Encourage self-management strategies and include realistic goal-setting.
• Physical/exercise therapy: Guidance on limits, avoiding flares, and graded progression.
• Incorporate psychological management: Acceptance is an important component.

These are all really useful things to keep in mind when you’re managing a patient with CRPS, but just as important as the content is the delivery – ‘painsplaining’ must be avoided at all costs! You can spout as many facts about pain science as you want, but learning is active, and patients need the right mindset and environment to engage effectively.

Wrapping up

By nature, CRPS is complex. Education is a foundational component of intervention for this condition.

The role of the physio is to keep patients informed through active learning, encourage self-management, support graded exposure to activity, and foster a sense of control and self-efficacy.

Want to know exactly how an expert does this? Watch Marc’s full Masterclass HERE.