Complex regional pain syndrome

Title

Other Names:

CRPS; Reflex sympathetic dystrophy

Categories:

Nervous System Diseases

Summary Summary

Complex regional pain syndrome (CRPS) is a chronic pain condition that mainly affects the arms, legs, hands, and feet, but may involve the entire body. CRPS symptoms often begin after surgery or an injury.^[1] The main feature of CRPS is continuous, intense pain that is out of proportion to the severity of the injury. The pain gets worse over time and often spreads throughout the entire affected area.^[2] Other symptoms may include color and temperature changes of the skin over the affected area; skin sensitivity; sweating; and swelling.^[1] The underlying cause of CRPS is often not known. Two classifications of CRPS have been recognized based on causalgia. Type I (also known as reflex sympathetic dystrophy), in which there is no evidence of peripheral nerve injury and Type II, in which peripheral nerve injury is present. Treatment aims to relieve pain and often includes different interventions such as topical or oral medications; physical therapy; and/or a sympathetic nerve block.^[2]^[3]

Last updated: 1/9/2017

Symptoms Symptoms

Complex regional pain syndrome (CRPS) usually develops after an injury, surgery, stroke or heart attack.^[4] The key symptom of CRPS is continuous, intense pain that is out of proportion to the severity of the injury. The pain gets worse over time. CRPS most often affects one of the arms, legs, hands, or feet, and the pain often spreads throughout the entire affected arm or leg.^[2] Other signs and symptoms may include:^[4]

sensitivity to touch or cold
swelling of the painful area
changes in skin temperature, color, and/or texture
joint stiffness and swelling
muscle weakness and/or muscle spasms

Symptoms may change over time and vary from person to person. In some people, signs and symptoms of go away on their own. In others, symptoms can persist for months to years.^[4]

Last updated: 11/11/2014

Cause Cause

The underlying cause of complex regional pain syndrome (CRPS) is not well understood. In most cases it occurs after an illness or injury that did not directly damage the nerves in the affected area (Type I). In some cases, it occurs after a specific nerve injury (Type II). The exact trigger of CRPS after an injury is not known, but it may be due to abnormal interactions between the central and peripheral nervous systems, and/or inappropriate inflammatory responses.^[3]

Last updated: 3/31/2016

Treatment Treatment

There is no known cure for complex regional pain syndrome (CRPS). Treatment includes a multidisciplinary approach with the aim of controlling pain symptoms. It has been suggested that when treatment is started within a few months of when symptoms begin, improvement or remission may be possible.^[3]

A combination of therapies is usually necessary including medications, physical and occupational therapy, interventional procedures, and psychosocial/behavioral management.

Medications may include:

Oral and topical pain relievers
Antidepressants or anticonvulsants (which are sometimes used to treat pain)
Corticosteroids
Bone-loss medications
Sympathetic nerve-blocking medications
Intravenous anesthetics (Ketamine)
Intravenous immunoglobulin

Interventional procedures may include:

Trigger/tender point injections
Regional sympathetic nerve block
Spinal cord stimulation
Epidural clonidine
Chemical or mechanical sympathectomy

Other therapies may include applying heat or cold; electrical nerve stimulation; and biofeedback.^[2]^[3]

Psychosocial and behavioral aspects of CRPS should be addressed, and it has been suggested that people with chronic CRPS should have a thorough psychological evaluation. This may be followed by cognitive-behavioral pain management, including relaxation training with biofeedback.^[5]

Unfortunately, published research studies validating the efficacy of these treatment options are limited and no single drug or therapy (or combination) has shown consistent, long-lasting improvement.^[2]^[3]

For more information on treatment options for CRPS, view information from the Reflex Sympathetic Dystrophy Association of America (RSDSA).

Last updated: 3/25/2016

Prognosis Prognosis

The long-term outlook (prognosis) for people with complex regional pain syndrome (CRPS) varies from person to person.^[4] In some people, signs and symptoms go away on their own; this is called spontaneous remission. In others, symptoms may persist for months or years and there may be irreversible problems.^[4]^[2] Treatment is likely to be most effective when it is started early in the course of the illness, so early diagnosis and treatment may improve the prognosis.^[4] The vast majority of children with CRPS have a good prognosis.^[6]

Last updated: 11/11/2014

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Research Research

Research helps us better understand diseases and can lead to advances in diagnosis and treatment. This section provides resources to help you learn about medical research and ways to get involved.

Clinical Research Resources

ClinicalTrials.gov lists trials that are studying or have studied Complex regional pain syndrome. Click on the link to go to ClinicalTrials.gov to read descriptions of these studies.

Please note: Studies listed on the ClinicalTrials.gov website are listed for informational purposes only; being listed does not reflect an endorsement by GARD or the NIH. We strongly recommend that you talk with a trusted healthcare provider before choosing to participate in any clinical study.

Organizations Organizations

Support and advocacy groups can help you connect with other patients and families, and they can provide valuable services. Many develop patient-centered information and are the driving force behind research for better treatments and possible cures. They can direct you to research, resources, and services. Many organizations also have experts who serve as medical advisors or provide lists of doctors/clinics. Visit the group’s website or contact them to learn about the services they offer. Inclusion on this list is not an endorsement by GARD.

Organizations Supporting this Disease

American Chronic Pain Association (ACPA)
P.O. Box 850
Rocklin, CA 95677-0850
Toll-free: 800-533-3231
Telephone: 916-632-0922
Fax: 916-632-3208
E-mail: ACPA@pacbell.net
Website: https://theacpa.org/
American RSD Hope Group
PO Box 875
Harrison, ME 04040-0875
Telephone: 207-583-4589
Website: http://www.rsdhope.org
Pain Relief Foundation
Clinical Sciences Centre
University Hospital Aintree, Lower Lane
Liverpool L9 7AL
United Kingdom
Telephone: 0151 529 5820
Fax: 0151 529 5821
E-mail: secretary@painrelieffoundation.org.uk
Website: http://www.painrelieffoundation.org.uk/
Reflex Sympathetic Dystrophy Syndrome Association of America (RSDSA)
PO Box 502
Milford, CT 06460
Toll-free: 877.662.7737
Telephone: 203-877-3790
E-mail: info@rsds.org
Website: http://www.rsds.org/

Do you know of an organization? Send us your suggestions.

Living With Living With

Living with a genetic or rare disease can impact the daily lives of patients and families. These resources can help families navigate various aspects of living with a rare disease.

Genetics Resources

To find a medical professional who specializes in genetics, you can ask your doctor for a referral or you can search for one yourself. Online directories are provided by GeneTests, the American College of Medical Genetics, and the National Society of Genetic Counselors. If you need additional help, contact a GARD Information Specialist. You can also learn more about genetic consultations from Genetics Home Reference.

Learn More Learn More

These resources provide more information about this condition or associated symptoms. The in-depth resources contain medical and scientific language that may be hard to understand. You may want to review these resources with a medical professional.

Where to Start

MayoClinic.com has an information page on Complex regional pain syndrome.
MedlinePlus was designed by the National Library of Medicine to help you research your health questions, and it provides more information about this topic.
The National Institute of Neurological Disorders and Stroke (NINDS) collects and disseminates research information related to neurological disorders. Click on the link to view information on this topic.
The National Organization for Rare Disorders (NORD) has a report for patients and families about this condition. NORD is a patient advocacy organization for individuals with rare diseases and the organizations that serve them.
Reflex Sympathetic Dystrophy Syndrome Association of America (RSDSA) offers information and support for Complex regional pain syndrome

In-Depth Information

Medscape Reference provides information on this topic. You may need to register to view the medical textbook, but registration is free.
The Monarch Initiative brings together data about this condition from humans and other species to help physicians and biomedical researchers. Monarch’s tools are designed to make it easier to compare the signs and symptoms (phenotypes) of different diseases and discover common features. This initiative is a collaboration between several academic institutions across the world and is funded by the National Institutes of Health. Visit the website to explore the biology of this condition.
Online Mendelian Inheritance in Man (OMIM) is a catalog of human genes and genetic disorders. Each entry has a summary of related medical articles. It is meant for health care professionals and researchers. OMIM is maintained by Johns Hopkins University School of Medicine.
Orphanet is a European reference portal for information on rare diseases and orphan drugs. Access to this database is free of charge.
PubMed is a searchable database of medical literature and lists journal articles that discuss Complex regional pain syndrome. Click on the link to view a sample search on this topic.

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What is the recovery or remission rate for complex regional pain syndrome? See answer
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