Complex Regional Pain Syndrome

Complex Regional Pain Syndrome (CRPS)

Complex regional pain syndrome (CRPS) can occur at any age, but usually affects men and women in their early- to mid-forties, with women more likely to be impacted. CRPS is chronic arm or leg pain that develops after an injury, stroke, surgery, or heart attack. The pain is localised and often disproportionate to the initial trauma.

Causes of Complex Regional Pain Syndrome

There are two types of CRPS:

  • Complex Regional Pain Syndrome I (Reflex Sympathetic Dystrophy); affecting 90% of people with CRPS and resulting of an injury or prolonged period of immobilization.
  • Complex Regional Pain Syndrome II (Causalgia); resulting of a nerve injury but pain is not limited to the site of the injury.
  • The cause of CRPS is unknown, however, in almost every case, no matter how severe, the pain originates after an injury or trauma. Potential causes are:

    • Prolonged immobilisation, such as being casted
    • Burns
    • Cuts
    • Bruises
    • Sprains
    • Surgery, even as minor as being stuck with a needle
    • Bone breaks and fractures


    Regardless the severity of the initial injury, CRPS symptoms may not present themselves right away. In every case, symptoms include a tingling or burning sensation in the lower and/or upper extremities. The pain may affect the entire leg or arm or may only influence one toe or finger. Other symptoms of CRPS include:


    Joint stiffness


    Skin hypersensitivity


    Skin texture change


    Difficulty moving the affected area


    Hair and nail growth pattern disruption


    Atrophy of muscles


    Swelling in and around joints


    Decreased range of motion


    Allodynia, or pain in the opposite limb


    There is no clear-cut test to diagnose CRPS. However, your pain management specialist will examine your medical history and may perform an MRI to detect changes in bone or circulation. Your pain management specialist will also perform tests to rule out other possible conditions.

    Possible Treatments

    Treatment options for CRPS often begin with OTC pain relief medication or prescription medications, such as pain relievers, corticosteroids, antidepressants, anticonvulsants, or bone loss medications. Physical therapy, psychotherapy, and biofeedback are additional common treatment options, but perhaps the most effective treatment option available in the United States is dorsal root ganglion stimulation.

    Dorsal root ganglion stimulation is a surgical procedure in which a pulse generator with leads attached is placed underneath the skin in either the abdomen or the buttocks. The leads send tiny electrical pulses to the dorsal root ganglion, the location in the spinal cord through which every sensory perception must pass, and thus, block the pain influenced by CRPS.

    Other interventional pain management treatments are:

    Sympathetic nerve blocks: a block to the sympathetic nerves is applied via an aesthetic adjacent to the spine
    Ketamine IV infusion therapy: ketamine is given intravenously over a period of several days.
    Surgical sympathectomy: the nerves contributing to CRPS are destroyed.
    Spinal cord stimulation: electrodes are placed adjacent to the spinal cord
    Intrathecal pumps: pain relief medication is sent to the pain site via an implanted catheter or pump.
    Dr.Raju Mantena
    Dr. Raju Mantena is an anesthesiologist and pain specialist based in the Houston area and has over 15 years of medical experience which he relies upon each day to successfully treat his patients’ acute and chronic pain.

    At 360 Pain Treatment, our mission is to provide compassionate pain relief, restore prior function and activity levels, and optimize the quality of life for all.


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