What is complex regional pain syndrome?

You may be recovering from an injury or surgery on a limb when the pain begins. For others, the pain begins without a clear cause. This is called complex regional pain syndrome (CRPS) or reflex sympathetic dystrophy. The cause of CRPS is not well understood.

For some people, the pain, swelling, and stiffness can be much worse than the original injury. This pain can last a long time—months or even years. Although it is an unusual condition, it is very real. You may feel better on some days than on others. Your skin may become very sensitive, and it may look blotchy or shiny. You may have trouble moving the limb.

This condition sometimes goes away after some months. More likely, you will need a treatment plan to reduce symptoms and prevent permanent damage. You may have to try several treatments before you find what works best for you. In some cases, shots into the nerve area (nerve blocks) seem to reduce symptoms. Pain medicine is only one part of successful treatment. Physical therapy and counseling can also help.

Symptoms of complex regional pain syndrome (CRPS) are usually only in one arm or leg and include:

• Pain that's much more severe and lasts much longer than what you would expect for the kind of injury you may have had.
• Skin that may be blotchy or shiny.
• Skin that may feel hotter or colder than other areas of your body.
• Swelling, joint stiffness, weakness, or shaking in the painful arm or leg.
• Sweating, numbness, or tingling in the painful arm or leg.

Like other conditions that cause chronic pain, CRPS can also cause sleeping problems, anxiety, mood swings, sadness, and depression.

When pain is extreme, some people who have CRPS think about death or suicide. If you or someone you care about talks about suicide or feels hopeless, get help right away.

Treatment for complex regional pain syndrome (CRPS) is divided into four areas:

• Pain management
• Physical rehabilitation (rehab)
• Counseling or psychotherapy
• Patient education and self–management

Pain management

The goal of pain management is to help you do more and feel better. It also helps you be able to do rehab.

Medicine can be used to help with pain from CRPS. There are different medicines that may be tried. You may also have medicine to help you sleep.

Medicine is only part of the treatment for pain from CRPS. Most people with CRPS see a pain specialist or go to a pain management clinic. You may work with different people for the various parts of your pain management plan.

Rehab

It may seem very odd that treatment for CRPS includes moving your painful limb, especially when any movement of that limb causes you severe pain. But occupational therapy and physical therapy are helpful parts of treatment for CRPS.

Most patients who have CRPS see a physical therapist or occupational therapist (or both). This type of therapy may not even involve touching your painful limb, at least at first. Gentle limb movement and treatment to help the limb feel more normal (called desensitization) are two therapies used for CRPS. After a period of time, you may move on to more active use of your painful limb, such as doing stretches or weight–bearing exercises.

Rehab may also include other treatment, such as:

• Mirror therapy. For this therapy, the therapist places a mirror so that the reflection of your limb that is not painful makes your brain think it is looking at your painful limb. When you look at this "virtual" limb in the mirror and you move it without pain, your brain "sees" painless movement in your painful limb.
• Transcutaneous electrical nerve stimulation (TENS).
• Hydrotherapy.
• Setting goals, pacing yourself, and prioritizing activity.
• Relaxation techniques.
• Sleep hygiene.
• Tai chi and qi gong.
• Electrical nerve stimulation.

Counseling

Counseling for CRPS includes ways to help you manage the pain and disability that comes from the condition. Cognitive–behavioral therapy (CBT) is the type of counseling used most often for CRPS. CBT can help you to:

• Look at–and change–the way you think about your condition.
• Change things you do (behaviors) that make the pain or disability worse.

CBT will also include training on:

• Coping skills.
• Relaxation.
• Activity and exercise, including taking breaks and pacing yourself.

Education

One of the best things you can do to help with CRPS is to learn everything you can about the condition. Your doctor (or doctors) should be able to help you with this. The more you know about what CRPS is and how you are affected by it, the better you will be able to help in your treatment.

Learn as much as you can so that you know the best ways to help yourself get better.

Complex regional pain syndrome (CRPS) is not common, so diagnosis can be hard.

There's no one test to diagnose CRPS. Your doctor will ask about your symptoms and past health. You will also get a physical exam. The exam may include touching your skin or bending your joints in the area that hurts.

Your doctor might also compare the color and temperature of the painful arm or leg with the matching, healthy one. For instance, if your left arm hurts, your doctor will compare it to your right arm.

More tests may be needed to rule out other possible causes of your pain and to make a correct diagnosis.

CRPS can be hard to diagnose. Your doctor may suggest that you see a specialist. This may be a neurologist, a rheumatologist, or a pain specialist.

• Try to relax and reduce stress. Relaxation techniques such as deep breathing or meditation can help.
• Keep moving, if you can. Gentle, daily exercise, such as walking or swimming, can help reduce pain over the long term.
• Apply a heating pad set on low or a warm cloth to the painful area.
• Gently massage the painful area.
• Get enough sleep. Talk with your doctor if you have trouble sleeping because of pain.
• Take your medicines exactly as prescribed.
  • Your doctor may have prescribed medicines used to treat depression and seizures. These medicines can reduce your pain, help you sleep better, and improve your mood.
  • If you are not taking a prescription medicine, ask your doctor if you can take an over-the-counter medicine.
  • Do not take two or more pain medicines at the same time unless the doctor told you to. Many pain medicines have acetaminophen, which is Tylenol. Too much acetaminophen (Tylenol) can be harmful.
• Keep a daily pain diary. Record how your moods, thoughts, sleep patterns, activities, and medicine affect your pain. Having a record can help you and your doctor find the best ways to treat your pain.
• Try to think positively. Remember that your thoughts can affect your pain level. Do things you enjoy to make yourself feel better when you have pain. See a movie, read a book, listen to music, or spend time with a friend. Let your doctor know if you are feeling depressed or anxious.

Complex regional pain syndrome (CRPS) is a painful condition that's often felt in an arm or leg, usually after surgery or injury. The pain is constant, sharp, or burning. It lasts longer than normal pain from a surgery or injury. Some people recover slowly. Others may have long-term pain and problems doing daily activities.

The cause of complex regional pain syndrome (CRPS) is not well understood.

The pain usually starts after a limb or joint has had a serious injury, such as a broken bone, a gunshot wound, or a deep wound. The injury might also be caused by an accident, a fall, or surgery. It can even be caused by a minor injury such as a sprain. For some people, CRPS starts without an apparent reason. It isn't clear why some people get CRPS while others do not.