Complex Regional Pain Syndrome is a neurological disorder characterised by a chronic pain condition in one or more limbs, affecting both sexes but is more prevalent in woman and people over the age of 40. The pain could be a result of damage or adaptive changes of the peripheral and central nervous system.


The individual suffering from CRPS often has abnormalities in their peripheral nerves, usually small unmeylinated and thinly myelinated nerve fibres that carry nerve pain signals to blood vessels, surrounding tissue, and the skin. This is one the factors thought to contribute to triggering symptoms of CRPS. Molecules secreted from the small nerves contributes to inflammation and abnormalities in the affected blood vessels leading to possible damage of the tissue.

The peripheral nerve abnormalities could affect the spinal cord and brain’s pain perception and lead to altered cortical function (how the brain perceives sensations).

More localised at the site of injury, blood vessels could leak fluid into the surrounding tissues causing redness and swelling. The swelling could negatively affect oxygen and nutrient supply leading to pain and possibly damage of the affected tissue.

CRPS also affects the immune system, high levels of Cytokines (inflammatory chemicals) have been found in the tissue of CPRS sufferers and the condition is more common with people suffering from conditions like asthma and other autoimmune conditions.

People with CRPS shows adaptive central motor functions and their pain is intensified when they perform certain movements, a study published in The Journal of Pain found pain could be reproduced in patients suffering from CRPS just by observing other people doing a similar movement that will cause pain in them selves.

The common symptoms of CRPS

It is characterised as a consistent and uncomfortable to severe pain that presents as a burning, pins and needles sensation or as if someone is squeezing the affected area.
The pain is not localised where the original injury occurred but can affect the whole limb and in some cases the spread to other areas of the body.

what is crps_2

There is often an increased sensitivity to touch in the affected area, even a light brush of material over the area could provoke a pain response.  People who are affected by CRPS could experience changes in temperature, skin colour and swelling in the affected limb which, is the result of changes in circulation to the affected area caused by damage to the affected nerves that controls the region.

There also could be changes in nail and hair growth patterns, excessive sweating, stiffness in joints, decrease in muscle coordination and also tremors and jerking of the affected limb.

Treatment for CRPS could be tricky as performing basic movements could aggravate the pain.

Treatment protocol usually includes pharmacological treatment to try and manage pain and inflammation, in extreme cases ketamine infusions are used to break the pain cycle. If medication does not work spinal cord stimulation could be attempted.

From a movement therapy perspective, first education about the condition is important and also strategies to cope with the pain like mindfulness is important. Graded motor imagery and mirror visual feedback of the unaffected limb could be attempted to ‘trick’ the brain into perceiving no pain in the affected limb.

Desensitisation of the affected skin area could be attempted, this could be stroking the skin with material or using your fingers.

As pain permits the limb should be used as much as possible through a full range of movement combined with visualisation exercises before performing the relaxant action. There is no steadfast rules with doing exercises – guide your intensity levels by the amount of pain you experience during or after exercise.

The idea is not to be in pain after the exercise, but try and keep the affected limb moving as much as possible!

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Hotta J1, Saari J2, Koskinen M2, Hlushchuk Y2, Forss N3, Hari R2.Abnormal brain responses to action observation in complex regional pain syndrome.
J Pain. 2016 Nov 12. pii: S1526-5900(16)30309-1. doi: 10.1016/j.jpain. 2016.10.017. disorders/reflex_sympathetic_ dystrophy/detail_reflex_ sympathetic_dystrophy.htm
Carr ES1, De La Cerda A1, Fiala K1. Complex regional pain syndrome.  Proc (Bayl Univ Med Cent). 2016 Jul;29(3):333-4.

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