What is Complex Regional Pain Syndrome?

Complex regional pain syndrome is chronic pain in the upper and lower limbs that typically occurs as a result of an injury or condition that causes dysfunction in the peripheral and central nervous systems. Complex regional pain syndrome may be accompanied by symptoms such as motor deficits and sensory problems.

This syndrome is characterized by pain that is significantly more intense than the severity of the injury or circumstance that caused it. While the symptoms are typically focused within one area, in some cases, they may spread to other parts of the body as well.

Other symptoms associated with this condition include:

  • Changes in skin color
  • Continuous burning or throbbing pain, typically originating from the peripheral nervous system
  • Sensitivity to touch or cold
  • Swelling
  • Changes in skin temperature (switching between feeling cold to being sweaty)
  • Changes in hair and nail growth
  • Joint stiffness
  • Muscles spasms
  • Muscles weakness or loss of muscle tone (atrophy)
  • Decreased ability to move the affected body part

Typically, symptoms of painful swelling and redness, along with notable changes in skin temperature and sensitivity to touch or cold are experienced at the onset of the condition. Emotional stress has been found to exacerbate symptoms. Over time, complex regional pain syndrome can lead to irreversible damage. Signs that typically indicate that the condition is immutable include loss in skin color (skin appears pale), skin temperature feels cold, muscle spasms, and muscle tightening.

Determining the exact cause of this pain syndrome can be difficult which makes it hard to treat at times, but nerve damage is typically believed to be responsible for the pain. Indeed, a procedure called a sympathetic nerve block has been shown to be effective at reducing the intensity of pain, thereby supporting the notion that this syndrome may be the result of nerve damage.

Causes of  Complex Regional Pain Syndrome

Nerve damage that causes complex regional pain syndrome is believed to be the result of conditions such as heart attack, stroke, a serious injury (e.g., spinal injury), or the side effects of surgery. These conditions are associated with excessive nerve inflammation and damage, which is believed to be the source of high levels of pain that do not correspond to the severity of the underlying injury or condition.
The neurological systems believed to be associated with complex regional pain are the peripheral and the central nervous systems. In terms of the peripheral nervous system, when the small nerve fibers that transmit information with blood vessels are damaged, they become overactive, leading to inflammation of the nerve along with disruption to the blood vessel, such as dilation, constriction, or leaking fluid into surrounding tissue. Blood vessel changes within the affected limb may also lead to symptoms. Muscles surrounding the affected blood vessels can became deprived of oxygen leading to muscle damage and pain, as well as joint pain.
While a large majority of complex region pain syndrome cases have an identified trauma or injury that is believed to be the cause of symptoms, some cases do not have an identifiable injury or trauma. The most common injuries include fractures, sprains, strains, injuries to soft tissue (e.g., bruises or cuts), immobilization of a limb, or injury resulting from surgery or other medical procedure. Indeed, cases of complex regional pain syndrome occurring without an identified trauma or injury are quite rare. It is believed that these cases are likely linked with an unknown underlying condition, such as an infection, blood vessel problem, or nerve entrapment. There is very limited data to suggest that complex regional pain syndrome has a genetic component. Moreover, there have been very few reports of complex regional pain syndrome cases occurring among members of the same family.

Treatment for Complex Regional Pain Syndrome

Patients who present with early onset symptoms of complex regional pain syndrome may alleviate their symptoms of poor circulation, inflexibility, muscle stiffness, and loss of muscle tone by doing physical therapy. Many patients who complete physical therapy early in the course of the condition may be able to prevent or even reverse some secondary changes in the brain that have been found to be linked to chronic pain.

IIn terms of pharmacotherapy, there are currently no medications that have been approved for the treatment of complex regional pain, though several medications are believed to provide patients with some relief.  A non-steroidal anti-inflammatory drug (NSAID) may help patients who are experiencing moderate pain. These medications are recommended because of their ability to reduce inflammation in the affected area. Oral corticosteroids, such as prednisone and cortisone, may also be recommended to reduce pain and inflammation of the affected area. Some medications that were originally developed to alleviate symptoms of depression have also been shown to be affective for neuropathic pain.

Patients may also experience a reduction in pain with spinal cord stimulation. This procedure involves implanting a device near the spinal column. This device delivers electrical impulses to control the transmission of pain signals from the nerves within the spine. Intrathecal pump implants can also provide patients with pain relief. This device pumps pain-relieving medications directly to the area surrounding the spinal cord.

In terms of alternative techniques, biofeedback training has received support for helping patients manage their symptoms of pain. This treatment involves teaching  patients relaxation and coping skills, thereby allowing them to gain some control over their pain symptoms. Other alternative techniques, including acupuncture, are also thought to be beneficial for symptoms associated with complex regional pain syndrome.


Complex regional pain syndrome is the result of a dysfunction in the peripheral and central nervous systems that causes chronic and severe pain in the limbs. In the majority of cases of complex regional pain a history of injury or trauma can be linked with the onset of symptoms; however, in some cases there is no identifiable cause. There are a number of treatment options available for managing the symptoms of complex regional pain syndrome. Patients are encouraged to speak with their physician about the course of their condition in order to determine the treatment plan that is right for them.

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