Complex regional pain syndrome (CRPS) is a syndrome that can occur after simple injuries such as a sprained ankle or a broken arm. While CRPS only affects a small proportion of people, it can be very painful and disabling. There are 2 main types of CRPS:
- Type I can occur after a simple injury such as a sprain or broken bone (hand or foot etc), after a stroke or without a known cause1.
- Type II can occur after injury or damage to a nerve in the arm or leg or after surgery to repair an injured nerve, for example carpal tunnel syndrome.
What are the features of CRPS?
It can be difficult for doctors to make a firm diagnosis of CRPS early in the course of the disorder when symptoms are few or mild. There are a number of features that may suggest CRPS I and II:
- severe pain, often out of proportion to the initial injury
- increased skin sensitivity
- excessive sweating or dryness of skin
- skin feeling warm or cold
- skin colour red or blue
- either extra or less hair growth in the area
- brittle finger nails
- muscle spasm, muscle contractures and difficulty coordinating and moving.
These features can spread so that the pain takes on a glove-like (hand/arm) and sock-like (leg) pattern of spread.
Have you got CRPS?
If you think you may have CRPS, seek help from your health professional. You can also complete our CRPS self-check in our pain self-checks page. This questionnaire is based on current best evidence research, however it is not perfect. It is not intended to replace a face-to-face clinical interview only to help screen for features of CRPS.
If you are experiencing significant physical or emotional difficulties you should contact your GP for a referral to a qualified health care professional. The prognosis (outcome) for CRPS varies1. Sometimes you can spontaneously recover. Other times, pain and disability can persist. More research is needed to understand the causes of CRPS, how it progresses, and the role of early treatment.
What can you do?
As a first step, you should have a medical review if you have not already done this. Currently there are not enough high quality studies to help make clear treatment decisions, at least for CRPS Type I1,2. We do not yet have enough evidence to tell us what the best treatments are for CRPS 1,2.
Below is a list of currently used treatments, however as there is not strong evidence to support these, you should discuss the treatments with your health professional:
- bisphosphonates, calcitonin or a daily course of intravenous ketamine for pain
- graded motor imagery may be effective for pain and function when compared with usual care
- mirror therapy may be effective for pain in post-stroke CRPS compared with a 'covered mirror' control
- local anaesthetic sympathetic blockade is not effective based on current evidence3
- physiotherapy or occupational therapy are associated with small positive effects that are unlikely to be clinically important at one year follow up when compared with a social work passive attention control2
You can read our CRPS pain management module to guide you about some of the current therapies that may be recommended to help you manage your pain, but bear in mind there is not strong evidence for these interventions as yet1. The training module is not designed as a standalone approach but to work along with your health care professional advice and treatments. If you are having trouble with pain control, medicines may be useful in the short term to help modify pain and allow you to undertake some mind-body re-training treatment.
If you're seeking further information about Complex Regional Pain Syndrome, we recommend you visit Cochrane Summaries and contact your local health professional for further assistance to better manage your pain.
- Bean DJ, Johnson MH, Kydd RR. The outcome of complex regional pain syndrome type 1: a systematic review. The journal of pain : official journal of the American Pain Society 2014; 15(7): 677-90. [PubMed]
- O'Connell NE, Wand BM, McAuley J, Marston L, Moseley GL. Interventions for treating pain and disability in adults with complex regional pain syndrome. The Cochrane database of systematic reviews 2013; 4: CD009416. [PubMed]
- Stanton TR, Wand BM, Carr DB, Birklein F, Wasner GL, O'Connell NE. Local anaesthetic sympathetic blockade for complex regional pain syndrome. The Cochrane database of systematic reviews 2013; 8: CD004598. [PubMed]