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What Is CRPS?
Symptoms
Causes
Diagnosis
Treatment
Living with CRPS
FAQs

Complex regional pain syndrome (CRPS) is a nervous system disorder that causes atypical, severe, and often long lasting pain in the body following an injury or health event.

What Is Complex Regional Pain Syndrome?

While it’s recognised by most health professionals, complex regional pain syndrome is relatively poorly understood, with many uncertain as to why some straightforward injuries or health events can trigger such severe and long-lasting symptoms in the body. In some cases, even a slight touch to the foot or leg has produced 10/10 extreme pain or burning sensations, with the affected area even becoming stiff or swollen at times - alongside various other symptoms.

The atypical nature of CRPS means that some people may not be taken seriously when describing their pain levels or what they’re feeling, leading to a delayed diagnosis. Others may comment that the sensations experienced are simply linked to a particularly ‘slow recovery’, instead of recognising the development of complex regional pain. The symptoms of CRPS can last for years, leaving those affected very frustrated, and significantly affecting their quality of life, as well as their mental and physical health.

CRPS is most often seen in those aged between 40 and 50 years, although it can occur at any point across the lifetime. Women are more often affected than men. CRPS shares many features with fibromyalgia, which is another type of pain syndrome. There are two types of CRPS.

• CRPS type one
  

CRPS type I occurs when there is no confirmed nerve injury or identifiable nerve damage associated with the condition. This type of CRPS tends to be triggered by a minor injury, trauma or event, such as a sprain, fracture, or surgery. Symptoms include severe, continuous pain that is disproportionate to the severity of the initial injury, along with sensory changes (such as sensitivity to touch or temperature), swelling, changes in skin colour and temperature, and impaired motor function.

• CRPS Type two
  

Type II occurs when there is a confirmed nerve injury or damage associated with the condition.

This type of CRPS is typically triggered by a more significant nerve injury, such as a laceration, crush injury, or nerve entrapment. Symptoms are similar to those in type one but may be more severe and may include additional neurological symptoms such as weakness, numbness, and abnormal sensations (such as tingling or burning) along the affected nerve.

Both types of CRPS share similar clinical features, including chronic pain, sensory abnormalities, motor dysfunction, and autonomic disturbances (such as changes in skin temperature, sweating, and swelling). 

What Are The Symptoms Of CRPS?

The hallmark feature of CRPS is persistent, severe pain that is disproportionate to the initial injury or trauma. These symptoms typically affect one limb, most commonly an arm or leg, but can occasionally spread to other parts of the body. Symptoms can develop gradually or rapidly, and can vary in severity. The nerves, skin, muscles, blood vessels, and bones can all be affected. Key symptoms include:

• Chronic pain: the most prominent symptom of CRPS is chronic, continuous pain that is often described as burning, stabbing, throbbing, or shooting. The pain may be localised to the affected limb or may spread to nearby areas. It can range from mild to severe and may worsen over time.
  

• Sensory abnormalities: those with CRPS may experience altered sensations in the affected limb, such as increased sensitivity to touch (allodynia), temperature changes, or pressure. Some may also experience numbness, tingling, or abnormal sensations (paresthesia) in the affected area.
  

• Changes in skin colour and temperature: the skin over the affected limb may appear mottled, blotchy, or discoloured, ranging from pale or cyanotic (blue) to red or purple. The skin may feel unusually warm or cold to the touch, with noticeable temperature fluctuations.
  

• Swelling and changes in skin texture: CRPS can cause swelling (edema) and inflammation in the affected limb, leading to changes in skin texture, such as shiny or glossy skin, or tightness and stiffness. In severe cases, the affected limb may appear atrophied (wasted) due to muscle weakness and disuse.
  

• Motor dysfunction: CRPS can impair motor function and mobility in the affected limb, leading to weakness, muscle spasms, tremors, or difficulty moving the limb. Some may develop muscle contractures or joint stiffness (arthrofibrosis) due to prolonged immobility.
  

• Autonomic disturbances: CRPS can disrupt the autonomic nervous system, leading to abnormal sweating patterns (excessive sweating or absence of sweating), changes in hair growth or nail growth, and alterations in blood flow (vasomotor symptoms), such as changes in skin temperature or texture.
  

Complex regional pain syndrome (CRPS) typically progresses through three stages of development, each characterised by distinct symptoms and changes in the affected limb. In stage one, those affected can experience severe burning or aching pain that intensifies with even the slightest touch or exposure to a breeze. Fluctuations in skin temperature, ranging from hot to cold, are common, along with rapid growth of hair and nails. Muscle spasms, joint pain, and changes in the skin's colour, appearance, and texture, such as pallor, redness, or mottling, may also occur. Additionally, increased sweating is often observed during this stage.

In stage two, which typically lasts between 3-6 months, symptoms progress as the skin continues to undergo changes and the nails become brittle and cracked. The intensity of pain increases, and hair growth slows down. Joints may stiffen, and muscles weaken, further contributing to functional impairment and discomfort.

If left untreated, CRPS may progress to stage three, where movement of the affected limb becomes difficult or too painful. This can lead to muscle and tendon wasting (atrophy) and contractures, resulting in permanent deformities and limitations in mobility. The changes observed in stage three can be irreversible, highlighting the importance of early intervention and comprehensive management strategies to prevent disease progression and optimise outcomes for individuals living with CRPS.

What Causes Complex Regional Pain?

In most cases, CRPS is triggered by an injury or trauma to a limb, such as bone fractures, muscle injuries, sprains, burns, or surgical procedures. However, the development of CRPS can also be associated with various medical events and conditions, including heart attacks, strokes, cancer, infections, and emotional stress. Additionally, an overreaction of the immune system is believed to contribute to the development of CRPS, leading to inflammation and abnormal responses in the nervous system. 

It is worth noting that while certain injuries or medical events may predispose individuals to CRPS, the exact reasons why some people develop the condition while others do not remain unclear. Factors such as genetic predisposition, underlying health conditions, and individual differences in pain perception and immune response may all play a role in the development of CRPS.

Some people may be at higher risk of getting CRPS following an injury than others including women, or people who have had severe trauma, a lower limb injury, especially the foot, or a work injury in a highly physical occupation. Also, people who have an injury with pain that is much greater than normal or who experience sensory changes such as allodynia are more likely to develop CRPS. People who smoke or have poor circulation, diabetes, autoimmune disorders, or prior nerve damage may have increased risk for CRPS. Genes can also play a role as families and siblings of people with CRPS may be more likely to develop CRPS at an early age. A few genes have been identified in families and populations affected by CRPS, but this is an evolving field.

Diagnosing CRPS

Diagnosing complex regional pain syndrome (CRPS) can be challenging due to the absence of definitive signs or specific diagnostic tests for the condition. Instead, healthcare providers rely on a combination of clinical assessment, medical history, and diagnostic tests to make a diagnosis.

At our clinic, our podiatrists will perform a thorough evaluation of the pain you’re experiencing, ruling out any other conditions that may share similar intense symptoms, which some nerve injuries do. We may order diagnostic imaging tests such as c-rays, bone scans, and magnetic resonance imaging (MRI) scans to assess for bone changes, soft tissue abnormalities, and other signs of CRPS-related pathology (as well as other pathologies). From here, depending on your symptoms, study findings and history, we will be able to make a diagnosis of chronic regional pain syndrome.

Treatment For Complex Regional Pain Syndrome

While the recovery for CRPS can vary greatly from person to person and predicting outcomes is very difficult, our podiatrists work to help you reduce and manage your pain as much as possible. Research shows that early treatment in the first three months of your symptoms may yield the most promising results, so try to book in as early as possible. This may also help prevent your CRPS symptoms from spreading elsewhere in the body.

Podiatry Treatment For Complex Regional Pain Syndrome

Our goal as podiatrists in the management of CRPS is to optimise your lower limb health, movement, function and comfort - so you can get the best results from your comprehensive and multidisciplinary approach to CRPS management. Our podiatrists will perform a comprehensive assessment that not only evaluates your CRPS and symptoms, but also the biomechanical characteristics (and other characteristics) of your feet and legs that may be adding to your pain levels - or have you moving suboptimally in a way that creates unnecessary strain or pressure. 

Podiatric support for CRPS focuses on functional rehabilitation, which involves keeping the affected limbs moving to help prevent the damaging effects on bones and tissues, maintaining good overall movement and flexibility, and also promoting your overall fitness, health and well-being. 

Your podiatrist will then create a tailored management plan for you that is non-invasive and evidence-based. This may include:

• Custom foot orthotics
  
• Custom footwear modifications or recommendations
  
• Dry needling
  
• MLS laser for pain relief
  
• Shockwave therapy
  
• A gentle physical therapy program including exercises for balance and stability
  
• Information about how to best manage CRPS day-to-day, and work towards getting the best outcomes
  

Living with CRPS: Coping Strategies and Lifestyle Modifications

Living with complex regional pain syndrome (CRPS) can present significant challenges, but adopting coping strategies and making lifestyle modifications can help individuals manage their symptoms and improve their quality of life. One key aspect of coping with CRPS involves developing effective pain management techniques, such as relaxation exercises, to help reduce pain intensity and improve overall well-being. 

Maintaining a balanced lifestyle that includes regular physical activity, adequate rest, and a nutritious diet can also help to optimise a person’s overall health and resilience in coping with the demands of CRPS. It's also important for individuals with CRPS to establish a trusted multidisciplinary team to support them in the various areas of their lives and help them get the best outcomes

 Frequently Asked Questions

What are the early signs of CRPS?

Early signs of complex regional pain syndrome (CRPS) may include severe, continuous pain that is disproportionate to the initial injury or trauma, along with changes in skin temperature, colour, and texture in the affected limb. Other symptoms may include swelling, stiffness, muscle weakness, and alterations in sweating patterns. Sensory abnormalities such as increased sensitivity to touch or temperature changes may also occur in the early stages of CRPS.

Can CRPS go away on its own?

While some individuals may experience spontaneous remission or improvement in symptoms over time, CRPS typically does not resolve on its own without intervention. Without appropriate treatment and management, CRPS symptoms may persist or worsen over time, leading to functional impairment and a decreased quality of life. Early diagnosis and comprehensive treatment are essential for improving outcomes and maximising the chances of symptom relief.

Is CRPS a progressive condition?

CRPS is considered a progressive condition, meaning that it can worsen over time if left untreated or inadequately managed. Without intervention, CRPS symptoms may spread to other parts of the body or become more severe, leading to increased pain, functional impairment, and disability. However, with early diagnosis, appropriate treatment, and proactive management strategies, it is possible to slow the progression of CRPS and improve outcomes for affected individuals.

Are there any alternative therapies for managing CRPS?

While conventional treatments such as medications, physical therapy, and interventional procedures are typically recommended for managing CRPS, some individuals may find relief from complementary and alternative therapies. These may include acupuncture, massage therapy, chiropractic care, biofeedback, and relaxation techniques such as yoga or tai chi. However, it's important to consult with a healthcare provider before trying any alternative therapies to ensure they are safe and appropriate for managing CRPS.

How can I support a loved one with CRPS?

Supporting a loved one with complex regional pain syndrome (CRPS) involves offering emotional support, practical assistance, and understanding. Listen to their concerns, validate their experiences, and encourage them to seek appropriate medical care and treatment. Help create a supportive environment that accommodates their needs, reduces stressors, and promotes relaxation. Educate yourself about CRPS to better understand their condition and advocate for their needs. Additionally, assist them with daily tasks, accompany them to medical appointments, and provide encouragement and reassurance throughout their journey with CRPS.