Complex Regional Pain Syndrome (CRPS)
Complex Regional Pain Syndrome (CRPS)
Complex Regional Pain Syndrome (CRPS) is a chronic pain condition that most often affects an arm or a leg, usually developing after an injury, surgery, stroke, or heart attack. The pain experienced is typically severe, continuous, and disproportionate to the initial injury.
Causes
- CRPS usually follows trauma or nerve injury but the exact cause is not fully understood.
- It may involve abnormal inflammation, dysfunctional nerve signaling, and altered blood flow regulation.
- Risk factors include peripheral nerve injury, hemiplegia, and possibly tobacco smoking, which may exacerbate sympathetic nervous system activity and vasoconstriction.
Symptoms
- Pain: Continuous burning, throbbing, stabbing, or stinging pain, often severe and disproportionate to injury.
- Sensory changes: Hyperalgesia (increased pain response) and allodynia (pain from normally non-painful stimuli like light touch or temperature changes).
- Swelling and stiffness: Joint swelling, stiffness, and decreased range of motion.
- Skin changes: Altered skin color (red, white, blue), temperature fluctuations (warm or cold), texture changes (shiny, thin, tender), and abnormal sweating.
- Hair and nail changes: Abnormal growth rates or brittleness.
- Motor symptoms: Muscle spasms, tremors, weakness, and difficulty moving the affected limb.
- Bone changes: Localized osteoporosis in the affected limb.
- Psychological impact: Chronic pain can lead to anxiety, depression, and sleep disturbances.
Symptoms often start near the injury site and may spread to other parts or limbs in some cases.
Clinical Course
- Early symptoms include pain, swelling, redness, and hypersensitivity.
- Over time, the affected limb may become cold, pale, and show muscle wasting or contractures.
- Some cases resolve spontaneously; others persist for months or years and may become irreversible if untreated.
Diagnosis
- Primarily clinical, based on history and characteristic signs and symptoms.
- Imaging and tests may be used to rule out other causes and assess bone changes.
- Early diagnosis is critical for effective treatment.
Treatment
- Early intervention offers the best chance of improvement or remission.
- Multimodal approach including physical therapy, pain management (medications, nerve blocks), psychological support, and sometimes surgical interventions.
- Stress management and relaxation techniques can help reduce flare-ups.
Epidemiology
- CRPS is uncommon.
- Females are about three times more likely to be affected than males.
- Most commonly affects adults around 40 years old.
- In adults, the arm is most frequently affected; in children, the leg.
Summary Table
| Aspect | Details |
|---|---|
| Definition | Chronic pain syndrome usually affecting limbs, with pain disproportionate to injury |
| Common Triggers | Injury, surgery, stroke, heart attack |
| Key Symptoms | Burning/throbbing pain, swelling, skin color/temp changes, hypersensitivity, motor dysfunction |
| Pathophysiology | Neuroinflammation, abnormal nerve signaling, blood flow dysregulation |
| Diagnosis | Clinical evaluation, exclusion of other causes |
| Treatment | Early physical therapy, pain control, psychological support, multimodal interventions |
| Prognosis | Variable; early treatment improves outcomes; chronic cases may have irreversible changes |
| Epidemiology | More common in females; peak onset ~40 years; arm most affected in adults |
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References
- Mayo Clinic. Complex regional pain syndrome – Symptoms & causes. 2022.
https://doi.org/10.1016/j.mayocp.2022.05.10
Mayo Clinic - Cleveland Clinic. Complex Regional Pain Syndrome (CRPS): Causes & Symptoms.
https://my.clevelandclinic.org/health/diseases/12085-complex-regional-pain-syndrome-crps - NHS. Complex Regional Pain Syndrome – Symptoms. 2022.
https://www.nhs.uk/conditions/complex-regional-pain-syndrome/symptoms/ - Better Health Channel. Complex regional pain syndrome (CRPS).
https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/complex-regional-pain-syndrome-crps - Wikipedia contributors. Complex regional pain syndrome. Wikipedia. 2025.
https://en.wikipedia.org/wiki/Complex_regional_pain_syndrome - National Institute of Neurological Disorders and Stroke (NINDS). Complex Regional Pain Syndrome Information Page.
https://www.ninds.nih.gov/health-information/disorders/complex-regional-pain-syndrome
Complex Regional Pain Syndrome is a challenging chronic pain disorder with complex neuroinflammatory and vascular components. Early recognition and multidisciplinary treatment are essential to improve outcomes and prevent long-term disability.
