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Complex Regional Pain Syndrome (CRPS)

CRPS is a chronic disabling neuropathic pain syndrome with severe pain, autonomic and motor dysfunction usually following limb injury.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

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This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Fizik Tedavi ve Rehabilitasyon department. Book Appointment →

What is Complex Regional Pain Syndrome (CRPS)?

Complex regional pain syndrome (CRPS) is a chronic regional pain disorder characterised by spontaneous and evoked pain disproportionate to any inciting event. It typically affects an extremity following trauma, surgery or fracture.

Two types: CRPS type I (without nerve injury, formerly reflex sympathetic dystrophy) and type II (with identifiable nerve injury, formerly causalgia). Diagnosis is clinical based on Budapest criteria.

Pathophysiology involves peripheral and central sensitisation, neurogenic inflammation, autonomic dysregulation, neuroplasticity, autoimmunity and psychosocial factors.

Early diagnosis and aggressive multimodal treatment within the first 6–12 months offer the best chance of resolution. Untreated CRPS may become chronic, with severe disability and psychiatric comorbidity.

Symptoms

Severe burning, stabbing pain disproportionate to injury, with allodynia and hyperalgesia
Vasomotor changes: skin temperature asymmetry, colour changes (pale, mottled, red, cyanotic)
Sudomotor changes: increased or decreased sweating, oedema
Trophic changes: shiny atrophic skin, hair and nail changes, joint stiffness
Motor dysfunction: weakness, tremor, dystonia, decreased range of motion
Sensory changes: hyperaesthesia, hypoaesthesia, neglect-like phenomena
Psychological distress: depression, anxiety, sleep disturbance

Risk Factors

Recent fracture (Colles' fracture is classic), surgery, sprain, soft-tissue injury
Female sex (3:1 ratio) and middle age (40–60 years)
Severe pain after the inciting event and prolonged immobilisation
Pre-existing pain catastrophising, depression, anxiety
Poor pain control during initial injury
Genetic factors and HLA-DR13 association
Inflammation markers and cytokine profile abnormalities

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Severe pain disproportionate to injury lasting >2 weeks — early specialist referral
  • Skin temperature, colour or sweating changes after injury — urgent assessment
  • Decreasing range of motion despite physiotherapy — multimodal approach needed
  • Sleep disturbance, depression or suicidal ideation — psychiatric intervention
  • Functional decline and inability to use the affected limb — comprehensive pain clinic

Treatment Methods

01
Multidisciplinary approach: physiatry, pain medicine, physiotherapy, occupational therapy, psychology
02
Active physiotherapy and occupational therapy: graded motor imagery, mirror therapy, desensitisation
03
Pharmacological: gabapentin, pregabalin, duloxetine, low-dose ketamine, bisphosphonates
04
Topical: lidocaine patch, capsaicin, DMSO cream, NSAIDs
05
Interventional: sympathetic ganglion block (stellate, lumbar), spinal cord stimulation in refractory cases
06
Cognitive behavioural therapy, mindfulness, relaxation techniques, biofeedback
07
Patient education, exercise progression, return-to-work and avoidance of immobilisation

Which Department to Visit?

You can visit our Fizik Tedavi ve Rehabilitasyon department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

Learn About Fizik Tedavi ve Rehabilitasyon Department

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.