Managing Complex Regional Pain Syndrome

Tip, tools and information to help you co-manage Complex Regional Pain Syndrome.

painHEALTH - Managing Complex Regional Pain Syndrome

Pain is usually the main symptom in people with Complex Regional Pain Syndrome (CRPS). You can be protective of the sore area, or you may avoid using the limb. While this approach can be helpful in the first few days after the injury, it quickly becomes unhelpful as the days and weeks go by. Your limb may get stiffer and more painful and you may become less able to move this affected body part – you may even feel like it does not belong to you.

The necessary and normal information that the brain receives when the body moves, is reduced when you stop moving your painful limb. Over time it becomes harder for your brain to recognise your body part, what it is doing and where it is in space. Moving that limb or body part may not feel normal, or is not so easy. It may even feel like it belongs to someone else.

Living with Complex Regional Pain Syndrome

When you have CRPS, the pain and other features are a lot more than might be expected for the original injury. Unfortunately, you might even be told “it’s all in your head”, but that’s not accurate or helpful.

We don’t yet fully understand the reasons why CRPS happens. Your pain and other features of CRPS can get worse if you are:

  • under emotional stress
  • if the temperature is cold
  • you are in an unfamiliar environment.

Light touch, feel, and movements can be very painful and this can be distressing. Other body parts become more sensitive too (meaning that the pain can spread). Moving the body can become more difficult (not just the sore part but other parts too or maybe half your body or one whole limb).

The good news is that in many cases these symptoms can improve and rehabilitation may be able to help with that process.

How do you treat and manage CRPS?

Because we don’t have a lot of evidence to go on, we don’t yet know the “perfect” way to treat CRPS.

Clinical guidelines, which represent the available evidence and the views of clinical experts in CRPS (for example1) suggest a number of treatments that may be helpful and there are things that you can try that may also help.

Take a look at our pain management modules that are designed to help address the typical factors affected when pain persists.

Many people will also need to see a doctor or a trained health care professional. The aim here is to have the right advice and the right treatment at the right time and by the right team. This team might include:

  • a GP who understands CRPS and can advise you regarding treatment options
  • a physiotherapist or occupational therapist skilled in CRPS management (ask if they have this experience or can refer you to someone who does)
  • sometimes it can be valuable to see a Pain Medicine Specialist (they can provide expert advice regarding pain modifying techniques and medications).

People with CRPS need good medical support and treatment. While this is not always possible, especially if you live in a rural or remote area, this website can help guide you in things that help improve your pain and function.

Recommended treatment combinations

Are there things that I can do to help now?

There are a number of strategies that people can find helpful for managing their symptoms, for example:

What about Rehabilitation?

All clinical guidelines3 recommend rehabilitation therapy as the first line of treatment and can be very important to your recovery. This might involve a team including a physiotherapist, an occupational therapist or a specialist nurse with skills in CRPS treatment.

There are a number of things these can help you with such as:

  • helping you to better understand your symptoms
  • giving you an exercise program to help get the limb moving
  • using techniques to reduce the sensitivity of the affected part
  • teaching you strategies to help manage your symptoms.

In some cases, exercises will be more focused on training how your brain perceives the affected part, than on actually moving the limb. Mirror therapy and graded motor imagery are examples of this (link to the interactive videos. There is some promising evidence to show these things can help, although importantly, they cannot yet be said to be “proven2.

What medications can help manage CRPS?

Medication can help but is not recommended as a standalone approach1. Medication is guided by your clinical presentation and so it is important to discuss this with your doctor so you get the right medication.

Medications vary and may be prescribed to help reduce swelling, inflammation, skin temperature problems or muscle stiffness and shaking. Your doctor may recommend medicines that are commonly used for other types of severe or persistent pain.  It is worth remembering that the brain’s chemicals and network connections involved in the lived experience of pain share similar pathways to those for the experience of depression and anxiety, so medications to help with depression are often used in chronic pain, however in differing doses. If you are experiencing low mood or anxiety, medication may help but it is also important to seek help for ways in which you can better cope and approach pain.

What other medical approaches are available?

If your symptoms are not improving you may be referred to a specialist pain management service. This may involve more specialist rehabilitation or pain management programme, trials of different medicines or more “invasive” medical procedures. For example, as well as the medicines that are commonly used for pain relief, there is some evidence3 that medicines known as bisphosphonates may be helpful in CRPS. These drugs are generally used for other conditions, particularly osteoporosis, but they may help some people with CRPS3. They are normally prescribed for CRPS by a pain specialist Doctor

Over the years, a lot of different treatments have been used for CRPS such as nerve blocks, delivery of medicines intravenously, and surgical approaches. Some of these have been shown not to work (for example intravenous nerve blocks with guanethidine3) and shouldn’t be offered, but for most it is simply not known if they are helpful3.

However, for severe and persistent cases of CRPS, there is some evidence that spinal cord stimulation, (in which small electrodes are surgically implanted in the nerves around the spine and the nerves are then stimulated with electrical current), may help improve pain and make it easier to use the affected limb3. You can find out more information about medicines and procedures by reading our medicines and procedures training module.

What if my mood is low or if I am not coping, distressed and anxious?

It is normal to have periods when you feel frustrated, low in mood, anxious and not coping. Remember to be kind to yourself, the pain is not your fault. You may benefit from utilising our pain management modules. You may need additional psychological support. If you feel you need additional support, it is important to contact your GP or health care professional for further assistance as soon as possible.

Further Information

For more information about CRPS management visit the International Research Foundation for RSP / CRPS. You can find consumer summaries though Cochrane Summaries. Alternatively, if you need to speak to your GP or health care professional, please seek further assistance.

  1. Goebel A, Barker CH, Turner-Stokes L et al. Complex regional pain syndrome in adults: UK guidelines for diagnosis, referral and management in primary and secondary care. Royal College of Physicians 2011; London [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. Cochrane Database of Systematic Reviews 2016; 2: CD010853. [PubMed]
  3. 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]

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.