Complex Regional Pain Syndrome (CRPS) overview

Pain that can develop after injury

Complex Regional Pain Syndrome, often referred to simply as ‘CRPS’, describes a type of pain suffered after either an injury or, more rarely, after a stroke or heart attack, after surgery or after a limb has been placed in a cast for a long period. It typically affects either an arm or a leg.

CRPS pain is generally of a level much higher than the injury or condition would normally cause, and is often accompanied by a range of other symptoms. It can be acute (ie short-lasting) or chronic (long-lasting ie 6 months or longer).

CRPS may be the result of a specific nerve injury (CRPS-2) or (CRPS-1).

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Possible causes of Complex Regional Pain Syndrome

How CRPS may develop

Medical science does not fully understand what causes CRPS, but it is believed that it is related to malfunction of, or injury to the peripheral nervous system. This then has a knock-on effect on the central nervous system, the spinal cord and the brain.

Current thinking is that injury to the affected limb causes damage to sensory and autonomic nerve fibres (also referred to as ‘small fibres’) that transmit pain signals and other sensory information and control smaller blood vessels. They are more prone to damage and malfunction as these nerve fibres, unlike other nerve fibres, do not have myelin coatings, which would to a degree protect them from damage.

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Complex Regional Pain Syndrome symptoms

Common signs and symptoms of CRPS

Apart from severe pain (much in excess of the original injury/cause), symptoms of CRPS can include one or more of the following:

Burning sensation

A burning feeling affecting the skin in the painful area.

Pins and needles

Tingling or prickling sensations in the affected area.

Skin hypersensitivity

Increased sensitivity to touch or pain from mild stimulus, including allodynia or hyperalgesia.

Mirror pain

Pain felt at the same location on the opposite limb.

Skin changes

Changes in skin temperature, texture or colouration.

Swelling or stiffness

Swelling or reduced movement affecting the painful limb.

Abnormal sweating

Increased sweating, or hyperhydrosis, in the affected limb.

Hair and nail growth changes

Hair or nail growth may become slower or faster than normal.

Bone growth changes

Bone growth in the affected limb may become slower or faster than normal.

Spasms or tremors

Involuntary muscle spasms or shaking may occur.

Fine motor difficulties

Reduced control of precise movements, particularly in the affected limb.

CRPS risk factors

Factors associated with developing CRPS

Certain things, referred to as ‘disease mechanisms’, are believed to be risk factors for developing the condition. These are:

  • Hereditary factors
  • Gender
  • Age
  • Smoking
  • Chemotherapy
  • Inflammatory response after an injury
  • Immune-related conditions, for example asthma

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CRPS tests and diagnosis

How CRPS is diagnosed

Diagnosis of CRPS generally involves an examination by a specialist (for example a neurologist) and identification of pain points and any other symptoms in order to identify the affected nerve/s. Specific tests are not needed to confirm a diagnosis of CRPS, but may be useful to diagnose other similar conditions.

Bone scans may be recommended (to identify any absorption of bone into the body which may indicate CRPS).

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