Complex Regional Pain Syndrome (CRPS): What It Is, Symptoms, and Treatment
Learn about complex regional pain syndrome (CRPS), its symptoms, causes, and effective strategies for relief.
Table of Contents
Nagging pain and odd sensations in an arm or leg after an injury or surgery. You might feel like you can’t move your limb normally, or have numbness, pain, weakness, and skin changes. You may even have the feeling that your limb “doesn’t belong” to you. These symptoms can be confusing and scary, but they might be signs of complex regional pain syndrome (CRPS). CRPS can cause a range of symptoms, but there are effective ways to manage it, and movement is key to recovery.
Here, learn more about what causes CRPS and how to treat it with physical therapy and other tips from our Hinge Health physical therapists.
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Our Hinge Health Experts
Claudia Canales, PT, DPT
What Is CRPS?
CRPS is a neuropathic pain disorder, or a type of pain problem that affects the nerves. It can occur after injury or surgery. It can cause extra sensitivity to touch, increased pain, changes in sweating and skin color, and changes in how your skin and nails look and feel. In some rare cases, CRPS can develop even without a significant injury or after minor events. The pain is worse than what you would expect from the original injury and lasts longer than it should.
There are two main types of CRPS:
CRPS-1 is more common and occurs without nerve damage.
CRPS-2 can occur after nerve damage.
CRPS can also be divided into "warm" and "cold" types:
Warm CRPS: The affected area feels warm to the touch.
Cold CRPS: The affected area feels cold to the touch and can be more challenging to treat.
What Causes CRPS?
Most people heal completely after surgery or an injury, but some experience lingering symptoms. Experts are still learning about CRPS, but it likely stems from a combination of factors, such as nerve injury, inflammatory processes, immune responses, and brain changes that affect how your brain perceives and communicates with your limb. Genetics may also play a role.
During the healing process, your nerves can become overly sensitive, leading to heightened pain responses and other sensations.
One way to think of CRPS is that it’s a stronger-than-normal response to injury.
Symptoms of CRPS
CRPS can cause a wide range of symptoms that persist after your initial injury or surgical site has healed, and they may spread beyond the original location. Some common symptoms include:
Pain and hypersensitivity, including sensations of burning, stabbing, stinging, tingling, and numbness.
Abnormal swelling, color, temperature, and sweating.
Difficulty moving a limb with weakness, tremors, and reduced range of motion.
Disturbances in body perception, which can change your awareness of limb position or size.
Emotional distress and anxiety due to pain and unfamiliar symptoms.
How Is CRPS Diagnosed?
Diagnosing complex regional pain syndrome (CRPS) involves a detailed medical history, physical examination, and the use of the Budapest Criteria, which assess ongoing pain, sensory changes, skin temperature and color alterations, swelling, changes to skin, hair, and nails, and your ability to move. Your provider may order imaging tests to rule out other conditions. Early diagnosis and treatment are crucial for managing CRPS effectively, so it's important to communicate openly with your healthcare provider about your symptoms.
Physical therapy (PT) is for more than just recovering from surgery or injury. It’s one of the top treatments for joint and muscle pain. It helps build strength, improve mobility, and reduce pain. And it doesn't always need to be in person.
Hinge Health members can conveniently access customized plans or chat with their care team at home or on the go — and experience an average 68% reduction in pain* within the first 12 weeks of their program. Learn more*.
CRPS Treatment
CRPS symptoms can be frightening and disruptive. But CRPS symptoms do not harm your body tissues, and most people with CRPS get better. Here are six ways to manage your CRPS symptoms:
1. Exercise and Physical Therapy
Movement is one of the most effective treatments for CRPS. Exercise can help you progress toward more active use of your painful limb — even if it temporarily increases your pain. Your provider can give directions for appropriate movement or refer you to a physical therapist for guidance. Exercises that can help include:
Gentle stretching to improve flexibility and reduce stiffness.
Exercises to improve the range of motion in your affected limb.
Strengthening exercises to gradually build strength in the muscles around the affected area to support your limb.
If pain is limiting your movement or ability to do daily activities, physical therapy (PT) can help. Physical therapists can assess you, rule out any serious causes of your pain, help you modify your activities, empower you with tools and tips to help you hurt less, and personalize your exercise program.
You can see a physical therapist in person or use a program like Hinge Health, where you may access a PT via telehealth/video visit.
2. Education
The more you understand about your condition and how your brain processes pain, the less pain you tend to experience. CRPS seems to involve nerves that are stuck on “high alert.” Studies show that learning about nervous system sensitivity and your body’s pain system leads to measurable improvement in pain. Simply understanding that some of the more worrisome symptoms are common for people with CRPS can help you manage your condition.
3. Pain Relief
It’s important to get early pain management with appropriate medications, especially when your pain is severe. Anti-inflammatory medications, anticonvulsants, antidepressants, and NMDA receptor antagonists can be helpful for CRPS pain. It’s important to make sure that you are safely able to take these medications, based on your medical history. Work with your provider to find pain medications that bring relief for your unique set of symptoms.
4. Desensitization Therapy
For severe pain, your provider may recommend desensitization therapy. This involves gradually exposing a hypersensitive area to different textures and temperatures, starting with light touch and soft materials, and increasing the pressure and roughness as your tolerance improves. Practice for short periods (three to five minutes) several times a day, focusing on the sensations and using relaxation techniques like breathing exercises.
5. Graded Motor Imagery (GMI)
Graded motor imagery techniques help gradually train your brain to tolerate and reduce pain associated with movement, especially when moving an affected limb is too painful.
If you have a painful hand, for example, GMI exercises might start with identifying right or left hands in images. From there, you might progress to imagining hand movements to get your brain accustomed to the idea of movement despite the pain. This can allow you to improve without actually moving the affected limb. Finally, you might practice movement with a mirror, using your unaffected hand to "trick" your brain into thinking that the painful hand is moving. These exercises are usually guided by a physical or occupational therapist, or other trained healthcare professionals.
6. Psychological Support and Stress Management
Pain is stressful and mental health conditions like depression, anxiety, and post-traumatic stress disorder (PTSD) can worsen CRPS pain. Seeking mental health support does not mean that CRPS is “all in your head.” A mental health provider can help you manage stress and learn breathing and relaxation techniques, coping skills, and other pain management techniques.
Contact your health insurance provider to find in-network mental health providers, or use online tools like Psychology Today and FindHelp to locate local support. You may also access confidential mental health support through your Employee Assistance Program (EAP). Call the NAMI Helpline (1-800-950-NAMI) or the National Suicide Prevention Hotline (988) for immediate crisis assistance.
More Ways to Manage CRPS
Here are other strategies that can help you manage CRPS:
Maintain a healthy diet. A balanced diet rich in anti-inflammatory foods can help reduce inflammation and improve overall health.
Stay hydrated. Drinking enough water can help reduce swelling and improve overall well-being.
Manage stress. Stress can exacerbate pain. Techniques like deep breathing, meditation, and yoga can help reduce stress and improve pain management.
Alternative and holistic therapies. Some people find therapies like acupuncture and chiropractic helpful for symptom control, even though they may not directly address CRPS causes.
Consult your healthcare provider. Discuss other treatment options, such as medications or nerve blocks, with your healthcare provider.
How Hinge Health Can Help You
If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.
The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you.
Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.
See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.
Looking for pain relief? Check if your employer or health plan covers our program
References
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