Complex Regional Pain Syndrome

Complex Regional Pain Syndrome (CRPS) is a chronic pain that usually affects an arm or a leg.

  • Typically develops after an injury including fractures, sprains/strains, soft tissue injury (burns, cuts, or bruises), limb immobilization, surgery, or medical procedures such as needle stick, stroke or a heart attack.
  • A hyperactivation of ascending pain pathways.
  • Pain is out of proportion to the severity of the initial injury.
  • Type I: develops after a noxious event
  • Type II: develops after a nerve injury


Symptoms develop over time, vary between patients.  May spread to elsewhere in your body, such as the opposite limb.

  • Burning or throbbing pain
  • Hypersensitivity
  • Edema
  • Changes in skin: temperature, color, texture
  • Abnormal sweating and hair growth
  • Muscle spasms, tremors, weakness, or atrophy
  • Joint stiffness or swelling
  • Decreased strength & endurance

Medical Treatment

  • Nerve block – injection of local anesthetic
  • Medication and drug pumps
  • Removal of neuroma/thickened nerve (controversial)
  • Spinal cord stimulation
  • IVIG (emerging)
  • Ketamine (emerging)
  • Alternatives: Behavior modification, acupuncture, relaxation techniques (biofeedback, progressive muscle relaxation, and guided motion therapy), and chiropractic treatment

OT Treatment

An exercise program to body part moving to improve circulation. Exercise can help improve range of motion, strength, and function.

  1. AROM – gentle, pain-free
  2. No PROM or painful treatment
  3. Stress loading
  4. Desensitization
  5. Tendon gliding
  6. Joint protection
  7. Edema management
  8. Pain management modalities
  9. Graded Motor Imagery (GMI), Mirror therapy (emerging)
  10. Psychotherapy
    • CBT – Cognitive Behavioral Therapy
    • ACT – Acceptance and Commitment Therapy