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What is Complex Regional Pain Syndrome?

What is Complex Regional Pain Syndrome?

Imagine a medical scenario when severe burning pain develops in an area of your body and starts spreading over a limp usually traveling to the opposite extremity or in other parts progressively becoming incapacitating and taking over your life. 

Enter the mysterious clinical world of complex regional pain syndromes.

Complex regional pain syndrome (CRPS) is a chronic pain condition that typically affects a limb, like a leg or an arm usually as a result of an injury. Damage or malfunction to the peripheral or central nervous system is what is believed to cause complex regional pain syndrome. In most cases, the condition is triggered by a clear history of trauma or injury. The most common triggers are fractures, sprains/strains, soft tissue injury (such as burns, cuts, or bruises), limb immobilization (such as being in a cast), surgery, or even minor injuries such as needle stick or stepping on a nail. CRPS represents an abnormal response that magnifies the effects of the injury. 

This condition is not common. In fact, it is difficult to diagnose and is historically tricky to treat.

Women are more likely to suffer than men, with the average age of sufferers of both gender between the ages of 40-60.

The affected area is not only extremely painful but other symptoms can include a change of body temperature, discoloration, and swelling in the affected area.

CPRS can be divided into two types: CRPS-I and CRPS-II.

Symptoms of CRPS

The hallmark symptoms of CRPS is allodynia and hyperpathia. Allodynia is a condition where a pain is produced by stimulus that is usually not painful (such as touching the skin with a feather or having pain when air touches the skin). Hyperpathia also known as hyperalgesia is a condition when a Usually painful stimulus causes much more pain than it would be typically produced (a minor scratch feeling like a stabbing pain).

Overall long-term pain is always present and constant feeling of things such as pins-and-needles as burning throbbing scalding severe penetrating radiating intolerable pain with the previously mentioned hallmark characteristics.

Pain has been known to spread, even if the affected area is only a hand or even finger. While this is rare, complex regional pain syndrome may spread to other extremities, such as the opposite limb or other area of the body. Over time, if CRPS is not treated, symptoms can become irreversible.

Other symptoms of CRPS can include:

Diagnosis and Treatment


CRPS is diagnosed based on a patient’s medical history and present symptoms. It is especially difficult to diagnose because the symptoms are common to other conditions as well. As a person’s symptoms improve, it is even more difficult to diagnose.

Certain tests are used to rule out other disorders and conditions that display similar symptoms, such as arthritis, Lyme disease, a clotted vein, or a general muscle disease. These tests can provide your physician with clues about what is causing your pain. A careful examination should be performed to determine if an injury is the root cause of the pain – the key feature to CRPS. Thorough examinations help assess the pain and determine if other treatable conditions are present and not ignored.

Imaging tests such as magnetic resonance imaging or triple-phase bone scans may be used to confirm a diagnosis. CRPS is often related to a process where certain cells break down bone and release calcium into the blood. However, this symptom can be caused by other diseases as well. X-Rays are used to show a loss of minerals from your bones. This is common in later phases of the disease. Sympathetic nervous systems tests look for disturbances in your sympathetic nervous system by using thermography to measure your skin temperature and blood flow. Other tests can measure the amount of sweat on your limbs. Irregular results can lead to an accurate prognosis of complex regional pain syndrome.

Treatment Options

Treatment Options

The goal of treatments is to lower the intensity of pain, avoid spreading of the symptoms, and interrupt the progression of the disease, while at the same time optimizing the patient’s functional capacity. Treatment of CRPS can be sometimes extremely difficult. The stage of CRPS different treatment options are available.

Therapies include:

The Important Role of Neuromodulation for the Treatment of CRPS

The Important Role of Neuromodulation for the Treatment of CRPS

There are two distinct types of non-pharmacological neuromodulation treatments applicable in the treatment of CRPS

The ACCURATE study, a pivotal, prospective, multi-center, randomized comparative effectiveness trial, was conducted in 152 subjects diagnosed with complex regional pain syndrome or causalgia in the lower extremities, receiving neurostimulation of the DRG or dorsal column (spinal cord stimulation, SCS).

Read full ACCURATE Study here


      1. Birklein F, Riedl B, Sieweke N, Weber M, Neundörfer B (2000) Neurological findings in complex regional pain syndromes—analysis of 145 cases. Acta Neurol Scand 101:262–269
      2. Psychological and behavioral aspects of complex regional pain syndrome management. Bruehl S, Chung OY. Clin J Pain. 2006 Jun;22(5):430-7 PMID: 16772797
      3. Cohen HE, Hall J, Harris N, McCabe CS, Blake DR, Jänig W (2012) Enhanced pain and autonomic responses to ambiguous visual stimuli in chronic Complex Regional Pain Syndrome (CRPS) type I. Eur J Pain 16:182–195
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      8. Ioannis Skaribas MD, Christian Pecora MD, Elena Skaribas RS, Neuromodulation: Technology at the Neural Interface, April 27, 2018 : Single S1 Dorsal Root Ganglia Stimulation for Intractable Complex Regional Pain Syndrome Foot Pain After Lumbar Spine Surgery: A Case Series.
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