Complex Regional Pain Syndrome (CRPS)

Pain out of proportion, plus changes in the limb

CRPS is a chronic pain condition that usually develops in an arm or leg after an injury, surgery, or sometimes a minor trauma. The hallmark is pain far out of proportion to the original event, typically burning, together with changes in the affected limb: swelling, changes in skin color and temperature, altered sweating, and extreme sensitivity, where even light touch or clothing hurts. It is a form of neuropathic pain, and in some people it is "sympathetically maintained," meaning the body's sympathetic nervous system keeps the pain going.

After early, active treatment

Early treatment matters a great deal: medication, and especially physical therapy to keep the limb moving, are the foundation, guided by a pain specialist. Sympathetic nerve blocks can both help and show whether the pain is sympathetically maintained. Surgery and neuromodulation are considered when the pain remains severe and disabling despite this care.

Surgical options

• Spinal cord stimulation (SCS)
  A well-established treatment for CRPS of a limb. Thin leads near the spinal cord deliver stimulation that reshapes the pain signal; it is trialed temporarily before a permanent device is implanted, so you can judge the relief first, and it is adjustable and reversible.
• Dorsal root ganglion (DRG) stimulation
  A targeted form of stimulation that is particularly effective for CRPS focused in one area, such as the foot, knee, or hand, that standard stimulation reaches less precisely.
• Sympathetic blocks and sympathectomy
  When the pain is sympathetically maintained, blocking the sympathetic nerves can give relief; in selected cases the sympathetic supply to the limb can be interrupted surgically.

See also