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Complex Regional Pain Syndrome

Complex Regional Pain Syndrome (CRPS) is a painful condition of a region of the body that usually occurs after an injury, most commonly a fracture. The condition varies in severity and can last for months or years. The cause of CRPS is not known, but early intervention can modify the course of the disorder. Therapy aims to relieve symptoms and restore limb function. CRPS is more common in smokers and is more likely to affect females than males. Post-menopausal women are at highest risk. In adults it most commonly affects the arm, while in children it most commonly affects the leg. CRPS is also known as Reflex Sympathetic Dystrophy (RSD).

Types of CRPS

CRPS has been divided into two different types:

  • CRPS 1 is a chronic nerve disorder that occurs most often in the arms or legs after a minor injury.
  • CRPS 2 is caused by an injury to the nerve.

Signs and Symptoms

  • Pain in the affected region.
  • Pain greater than expected for the injury that has occurred.
  • Stiffness.
  • Swelling.
  • Skin changes.
  • Shiny skin.
  • Changed temperature of the region.
Illustration of complex regional pain syndrome affecting the hand

Cause

While the cause of CRPS is uncertain, it is thought to result from dysfunction of the nervous system. There is no cure and no single recommended treatment. Some evidence suggests that vitamin C (500mg daily) taken after a wrist fracture may reduce the risk of developing CRPS – see the Cochrane review under Further Resources below.

Diagnosis

CRPS is diagnosed clinically, based on internationally recognised criteria maintained by the International Association for the Study of Pain (IASP) – commonly known as the Budapest Criteria. Diagnosis is generally made by a treating doctor or pain specialist rather than by a single test. See the IASP resource under Further Resources below for the full criteria.

Treatment

Dr Tomlinson does not manage CRPS directly. Where CRPS is suspected or diagnosed, she refers patients to a pain management specialist for multidisciplinary care, which commonly involves a pain specialist, hand therapist, psychologist and broader care team.

Treatment modalities may include:

  • Medications.
  • Physical therapies, including active and passive joint range of motion, stress-loading activities, desensitisation techniques and sensory re-education.
  • Counselling and psychological support.
  • Interventions such as nerve blocks, including sympathetic ganglion blocks.
  • Implant therapy (generally considered as a last resort).

Further Resources