Complex Regional Pain Syndrome

Learn about Complex Regional Pain Syndrome (CRPS) as a musculoskeletal pain condition to identify how you can approach CRPS to form your co-management treatment plan.

painHEALTH - Complex Regional Pain Syndrome

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:

  1. 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.
  2. 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
  • swelling
  • 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 guide clear treatment decisions in CRPS.2 Clinical guidelines, which represent the available evidence and the views of clinical experts in CRPS (for example 3) suggest a number of treatments that may be helpful.

All clinical guidelines recommend rehabilitation therapy as the first line of treatment. This might be delivered by a physiotherapist, an occupational therapist or a specialist nurse. This usually involves things like education on how to best manage your symptoms, graded exercises and sometimes even brain training techniques to help to reduce the pain. There is some promising evidence to show these things help although they cannot yet be said to be “proven”4.

As well as rehabilitation therapy, there are some drugs that may help. We do not know exactly which medicines are best for helping the pain of CRPS though your doctor may recommend medicines that are commonly used for other types of severe or persistent pain (see our Medicine and procedures module). With any medicine therapy, your progress should be reviewed regularly by your doctor. If the medicine is not helping you, or is causing you problems, you can consider trying a different treatment. Your GP may choose to refer you to a more specialist doctor, for example a Pain specialist or a Rheumatologist.

If your symptoms are not improving, you may be referred to a specialist pain management service. This may involve more specialist rehabilitation therapy, trials of different medicines or more medical procedures (see our page on Managing CRPS).

So, to summarise – if you think you may have CRPS:

  • See your GP to discuss your symptoms
  • If CRPS is the problem seek a referral to a rehabilitation therapist, preferably with CRPS experience
  • Talk to your Doctor about possible medicines for pain relief
  • If things are not improving, talk to your health professional about referral to a specialist service.

Further information

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.

Pacing and goal settings

Approaching Pain

Mindfulness and pain

Chronic and Non-Cancer pain management plan

  1. Bean DJ, Johnson MH, Kydd RR. The outcome of complex regional pain syndrome type 1: a systematic review. The Journal of Pain 2014; 15(7): 677-90. [PubMed]
  1. Goebel A. Complex regional pain syndrome in adults. Rheumatology. 2011;50(10):1739-50. [PubMed]
  1. 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]
  2. Smart KM, Wand BM, O’Connell NE. Physiotherapy for pain and disability in adults with complex regional pain syndrome (CRPS) types I and II. The Cochrane database of systematic reviews. 2016;2:CD010853. [PubMed]

This module has been developed by Neil O’Connell PhD, MSc, Senior Lecturer, Department of Clinical Sciences, College of Health and Life Sciences, Health Economics Research Group, Institute of Environment Health and Societies, Brunel University London, UK; Sonia Ranelli PhD, MSc, BSc(Physiotherapy), Lecturer, School of Physiotherapy and Exercise Science, Curtin University, Perth Australia and Helen Slater, PhD, FACP, Associate Professor, School of Physiotherapy and Exercise Science, Curtin University, Perth Australia. The information in this module is based on current best evidence research and clinical practice.


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