Complex Regional Pain Syndrome

Complex regional pain syndrome (CRPS) is a debilitating, chronic pain condition that usually affects an arm or leg following an injury, surgery, or stroke. CRPS is believed to be a disorder of the nervous system. Specifically, a dysfunctional interaction between your central and peripheral nervous systems and inappropriate inflammatory responses. CRPS is classified into two types:

  • Type 1 CRPS, formerly called reflex sympathetic dystrophy (RSD), usually follows a minor injury that doesn’t cause nerve damage, like a sprained ankle or surgery. This accounts for 90% of cases.
  • Type 2 CRPS, formerly called causalgia, develops after a more severe injury or an infection that damages a nerve.

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Hallmark symptoms and signs of CRPS were defined in the Budapest Criteria below:

  • Persistent, severe pain, disproportionate to the inciting event
  • Often CRPS is progressive and worsens over time.
  • Hypersensitivity or allodynia (severe pain with stimuli that would otherwise not be painful, like light touch)
  • Temperature difference, skin color changes
  • Swelling or edema
  • Decreased range of motion, stiffness, weakness, withering of the extremity


Early diagnosis and treatment of CRPS is critical in successful treatment. The Compass Pain and Spine can diagnose CRPS during a comprehensive history and physical examination. In addition, we may also request diagnostic tests such as an MRI, blood tests, EMG/NCS.


Early diagnosis and treatment of CRPS is critical in successful treatment.

  • In mild cases of CRPS, physical therapy +/- medications may be sufficient to overcome symptoms and regain function.
  • In more severe cases, the Compass Pain and Spine may employ special injections, called sympathetic nerve blocks to reset the body’s malfunctioning nervous system in addition to physical therapy.
  • In severe, refractory cases we may recommend a trial of neuromodulation (SCS) to change how your body is perceiving pain in addition to physical therapy.


Studies have shown that high dose vitamin C after a wrist fracture may have a lower risk CRPS compared with those who did not.