Complex regional pain syndrome (CRPS)

About CRPS

Although most cases of CRPS are triggered by an injury, the resulting pain is much more severe and long-lasting than normal.

Many cases of CRPS gradually improve to some degree over time. Some cases of CRPS never go away, and the affected person will experience pain for many years.

Symptoms of CRPS

The main symptom of complex regional pain syndrome (CRPS) is pain. The pain can sometimes be severe, continuous and debilitating. It's usually confined to one limb, but can spread to other parts of the body in some cases.

Chronic pain

The pain associated with CRPS is usually triggered by an injury. But it is a lot more severe and long-lasting than would normally be expected.

The pain may be a mix of burning, stabbing or stinging sensations. But there may also be a tingling sensation and numbness.

You may have periods of pain lasting a few days or weeks, called flare-ups, where the pain gets worse.

Stress, in particular, can lead to flare-ups. This is why relaxation techniques and mindfulness training can be an important part of treating CRPS.

If you have CRPS, your skin in the affected area can become very sensitive. Even the slightest touch, bump or change in temperature can provoke intense pain.

Other symptoms

As well as chronic pain, CRPS can also cause a range of other symptoms, including:

• strange sensations in the affected limb – it may feel as if the affected limb doesn't belong to the rest of your body, or it may feel bigger or smaller than the opposite, unaffected limb
• alternating changes to your skin – sometimes your skin in the affected limb may be hot, red and dry, whilst at other times it may be cold, blue and sweaty
• hair and nail changes – your hair and nails in the affected limb may grow unusually slowly or quickly and your nails may become brittle or grooved
• joint stiffness and swelling in the affected limb (oedema)
• tremors and muscle spasms (dystonia)
• difficulty moving the affected body part
• difficulty sleeping (insomnia)
• small patches of fragile bones (osteoporosis) in the affected limb – although there's no evidence this could lead to fractures

In very rare cases, CRPS can also lead to further physical complications.

These include:

• skin infections and ulcers (open sores)
• muscle atrophy (where the muscles begin to waste away)
• muscle contractures (where the muscles shorten and lose their normal range of movement)

Some of these problems can make it very difficult for people with CRPS to move around.

Psychology in CRPS

The emotional strain of living with chronic pain can sometimes lead to psychological problems, such as depression and anxiety.

During periods of extreme pain, some people may even consider suicide.

See your GP as soon as possible if you've been experiencing feelings of depression or suicide. They'll be able to provide help and support.

• Mental health emergency - if you're in crisis or despair

When to get medical advice

You should see your GP if you have persistent pain that's preventing you from carrying out everyday activities.

CRPS can be difficult to diagnose because it involves a number of tests to rule out other possible causes.

It's best to seek help as soon as possible, because early treatment may reduce unnecessary suffering.

Causes of CRPS

The cause of CRPS is unknown, but it's thought to be the result of the body reacting abnormally to an injury.

It used to be thought that CRPS was a psychosomatic condition (the symptoms were "all in the mind") but research has disproved this.

Who is affected

It's difficult to estimate exactly how common CRPS is, as many cases may go undiagnosed or misdiagnosed.

CRPS can begin at any age, including in children, although the average age for symptoms to start is around 50. Women make up around three out of four cases.

Treating CRPS

Treatment for CRPS involves four main aspects:

• education and self-management – being given clear information about your condition and advice on any steps you can take to help manage your condition yourself
• physical rehabilitation – treatment to help manage your symptoms and reduce the risk of long-term physical problems, such as physiotherapy exercises
• pain relief – treatments to help reduce your pain, such as anticonvulsants or Antidepressants
• psychological support – interventions to help you cope with the emotional impact of living with CRPS, such as cognitive behavioural therapy (CBT)

Due to the complex nature of CRPS, a number of different professionals will usually be involved in your care.

The treatment you receive will depend upon your symptoms, how severe they are and what works for you. This will be discussed with you to help decide the best approach.

• Complex regional pain syndrome

More useful links

• How to use your health services
• Samaritans
• Minding your head