Complex regional pain syndrome explained

Complex regional pain syndrome (CRPS) involves severe, persistent pain, usually affecting 1 limb. Find out how to manage symptoms.

What are the symptoms?

What causes it and who can be affected?

When to see a doctor

How is it diagnosed?

What are the treatments?

Self-care tips to help

Where to find support

With complex regional pain syndrome (CRPS) can make you feel severe, persistent pain, usually in 1 limb. It may get better on its own, but it can take time to go away. Discover the possible causes of CRPS, and what you can do to manage it.

Complex regional pain syndrome (CRPS) involves debilitating pain, typically in 1 of your limbs, such as a hand, arm, leg, or foot. Sometimes, it may spread to other parts of your body. 

It normally starts after an injury. While you’d expect to feel pain after injuring yourself, CRPS is different because the pain is more severe and lasts much longer than normal.

Sometimes, healthcare professionals divide the condition into 2 types, although symptoms are similar in both:
- __type 1__ follows an illness or injury such as a fracture or strain, where there’s no direct nerve damage – this is the most common form, affecting 90% of people with the condition.
- __type 2__ develops after nerve damage to the affected area.

In some people, CRPS symptoms get better after a few months, and don’t come back. But 10-30% of people have repeated episodes throughout their lives.

CRPS isn’t well understood, and there’s no cure. But you can often manage symptoms with a combination of different treatments.


## What are the symptoms?
The main symptom is long-term (chronic) pain, usually after an injury. You may have flare-ups, when the pain gets worse for a few days or weeks. 

The pain may feel like a mixture of burning, stabbing, or stinging, and you may have some tingling and numbness. As skin in the affected area may become very sensitive, even a light touch, pressure to the skin, or change in temperature can cause severe pain.

The pain can spread so if your finger or hand was injured, CPRS could go on to affect your whole arm.

CRPS can also cause other symptoms, which may include:
- strange sensations in your affected limb – for example, it may feel as though it doesn’t belong to your body, or as though it’s a different size to the unaffected limb
- joint stiffness and swelling in the affected limb
- skin changes – the area may switch between hot, red, and dry, and to cold, blue, and sweaty. Color changes may be harder to see on brown and black skin
- muscle spasms, tremors or weakness
- difficulty moving the affected limb
- sleep problems
- changes to nail and hair growth on the affected limb
- depression or anxiety, as a result of living with long-term pain.


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## What causes it and who can be affected?
Doctors don’t know exactly what causes CRPS. It usually develops within 1 month of an injury, which could have been either a minor or more serious injury. The most common injury associated with developing CRPS is a bone fracture, especially a wrist fracture. 

But CRPS can also start after sprains, burns, cuts and grazes. And it may occur after you’ve had surgery on your limb, or the limb’s been immobilized for a while – for example, in a plaster cast. Sometimes, a heart attack or a stroke may trigger it.

Around 1 in 10 cases of CRPS have no obvious cause or trigger.

Experts don’t know why CRPS develops in some people after an injury. They think it may occur when an injury triggers an abnormal inflammatory or immune response in both your peripheral and central nervous systems.

Studies suggest that women are 3-4 times more likely than men to be affected. It seems to be more common from around the age of 40, but anyone of any age can develop CRPS.


## When to see a doctor
If you think you may have [symptoms](https://www.livehealthily.com/health-library/conditions/complex-regional-pain-syndrome#symptoms) of CRPS, or ongoing pain is affecting your daily life, speak to your healthcare professional. 

Early diagnosis of CRPS is important. Prompt treatment may help to improve symptoms, but if left untreated, pain may get worse, and your affected limb might become stiff and harder to move. Without treatment, it’s possible that symptoms may eventually become permanent. So don’t put off seeing your healthcare professional. 


## How is it diagnosed?
There’s no specific test for CRPS, which can make diagnosis challenging.

Your doctor will begin by asking about your symptoms and any recent injuries or surgeries. They will check for common symptoms of CRPS, such as skin sensitivity, discoloration, swelling, and reduced range of motion.

CRPS is usually diagnosed after ruling out conditions with similar symptoms, such as rheumatoid arthritis. Your healthcare professional may recommend tests, such as:
- blood tests
- an X-ray
- an MRI scan
- nerve conduction studies, which check for damage to nerves.


## What are the treatments?
Around 85% of people with CRPS find their symptoms gradually improve over 2 years, but some experience ongoing pain, even with treatment.

Your healthcare professional will probably recommend a treatment plan that involves 4 main areas:
- guidance on [self-care measures](https://www.livehealthily.com/health-library/conditions/complex-regional-pain-syndrome#selfcare) that may help you manage symptoms
- physical therapy to help improve the way you move, and maintain strength and flexibility
- pain relief, which may include various medications, such as anticonvulsants or antidepressants, and sometimes a procedure called spinal cord stimulation, if medication doesn’t help
- psychological support – talking treatments may help you cope better with pain, and manage the emotional impact of CRPS.


## Self-care tips to help
Your healthcare professional will recommend things you can do yourself to help – this is a key part of your treatment. For example, they may suggest:

- getting the right information to help you understand your condition
- ways you can stay active with gentle exercise like walking or swimming to keep the affected limb moving and help reduce long-term pain
- techniques to help you manage pain flare-ups
- relaxation methods such as deep breathing or meditation to improve your quality of life
- joining a support group.
- 
It’s also important to keep following the rehabilitation treatments your healthcare professional recommends.

You may find other things that help you manage symptoms. For example:
- keeping a pain diary, which may help you understand whether anything makes your pain better or worse
- prioritize getting enough sleep
- using a warm heat pad on your painful limb
- gently massage the painful area
- using pillows to elevate the affected limb overnight
- stop smoking – smoking affects nerve regeneration.


## Where to find support
It may be helpful to speak to others living with pain, who understand what you’re going through. 

These groups offer support and advice:
- Pain Canada: [www.paincanada.ca/](https://www.paincanada.ca/)
- US Pain Foundation: [uspainfoundation.org/](https://uspainfoundation.org/)
- Action on Pain (UK): [action-on-pain.co.uk](https://action-on-pain.co.uk/)

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References

Chantelle Pattemore

Dr Maria Reza

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