Complex Regional Pain Syndrome or CRPS is a type of chronic pain and aching that generally affects a leg or an arm of the patient. The condition usually develops when the person has sustained an injury, or after a surgery, stroke, or heart attack. The most common symptoms of complex regional pain syndrome include:

  • Constant burning and hurting pain in the arm, hand, leg, or foot
  • Sensitivity to heat, cold, or touch
  • Swelling and inflammation of the painful region
  • Frequent changes in the skin temperature
  • Abnormal changes in the skin color, which might range from white to red or blue
  • Unusual changes in the skin texture in the painful area, which might range from tender to thin and shiny
  • Joint pain and stiffness or swelling
  • Muscles spasms, weakness, and tremors
  • Low ability to move the painful body part

The symptoms of complex regional pain syndrome vary from one person to another and might change over time as well. Usually, pain and inflammation, skin temperature variations, and hypersensitivity issues occur at first. Gradually, the affected area becomes pale and cold, which is followed by muscle spasms and movement problems in the later stages. Note that the skin and nail changes are often irreversible, which is why it is recommended to consult with a doctor at the nearest community healthcare center as soon as any early signs of the condition are noticed.

In some cases, the symptoms of complex regional pain syndrome can spread to the opposite limb as well. While most of the symptoms of the condition like pain and inflammation go away on its own after some time, some may persist for years. Therefore, it is advised to see a doctor if you experience constant and severe pain in a limb, which makes it difficult to touch or move that part. Starting the treatment as early as possible is very much important to deal with the condition effectively.


The actual cause of complex regional pain syndrome is not yet understood completely. Experts believe that the condition results as an after-effect of an injury or due to an abnormality of the peripheral and central nervous systems. Typically, there are two forms of complex regional pain syndrome: reflex sympathetic dystrophy syndrome or RSD and causalgia. The former type occurs when the person has sustained an injury, which did not damage the nerves in the affected region directly, while the latter occurs after an illness or injury has led to nerve damage in the limb.

Most cases of CRPS are reported after a forceful trauma to the limb, such as an injury, fracture, or amputation, while other traumas like surgery, stroke, or a heart attack can also lead to the condition. In some cases, even minor issues like sprained ankles or infections can also lead to complex regional pain syndrome. However, it is not clear why such traumas trigger the condition; not all who experience such traumas develop complex regional pain syndrome either. It is presumed that the condition happens because of a dysfunctional communication between the peripheral and central nervous systems and due to wrong inflammatory responses.

Although the condition is very rare, it can lead to many serious complications if not treated in time. In severe cases, the skin, bones, and muscles in the affected area might become weak and start to deteriorate. This is especially the case when the patient is facing difficulties in moving the arm or leg because of pain and/or stiffness. The patient might also experience muscle tightening, which could gradually lead to a condition where the toes and fingers would contract into a fixed position.


Doctors at community healthcare centers often recommend a combination of treatment methods to deal with complex regional pain syndrome. Generally, pain relievers such as aspirin, ibuprofen, and naproxen sodium are prescribed to the patient to help with the pain and swelling. Along with that, antidepressants, such as amitriptyline, and anticonvulsants, such as gabapentin, are also recommended to treat pain resulting from nerve damage. In some cases, doctors might also prescribe corticosteroids, such as prednisone, to reduce the inflammation in the affected area as well as to improve the movement of the limb.

If the condition has already aggravated to a severe stage, the doctor might prescribe bone-loss medications, such as alendronate and calcitonin, to prevent any further damage to the bones. Similarly, nerve-blocking medications might also be prescribed to reduce the constant pain by blocking pain fibers in the affected nerves. Studies show that low doses of intravenous ketamine can also help to alleviate pain in severe cases of complex regional pain syndrome, but it does not help with relieving other symptoms of the condition.

Therapies such as heat therapy, physical therapy, spinal cord stimulation, and transcutaneous electrical nerve stimulation might also be recommended to ease the symptoms of the disorder. In some cases, topical analgesics, such as capsaicin cream or lidocaine cream, are also prescribed to reduce hypersensitivity of the skin.

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    About the Author

    Dr. Ghassan M. Al-Jazayrly, MD

    A graduate of University of Aleppo Faculty of Medicine, Dr. Al-Jazayrly or, as he is colloquially known: Dr. AJ, is an oncologist and hematologist of a Complete Care Community Health Center (CCCHC) with more than 36 years of experience. In recent years, he’s been involved with a non profit organization known as Every Woman Counts (EWC) which provides free breast and cervical cancer screening and diagnostic services to California’s underserved populations in order to eliminate health disparities for low-income individuals.

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