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Complex Regional Pain Syndrome

CRPS is uncommon, distinctive and time-critical. Early movement and early recognition make a substantial difference.

Overview

What It Is

Complex regional pain syndrome is severe pain in a limb, out of all proportion to the injury that preceded it, accompanied by changes in colour, temperature, sweating and swelling. It usually follows a fracture, surgery or a relatively minor injury. Early recognition matters because outcomes are considerably better when treatment starts within the first few months.

Time-critical

Disproportionate and Distinctive

Severe pain out of proportion to the injury, with colour, temperature, sweating and swelling changes in the limb.

Symptoms

How It Tends to Feel

These are the features that point towards this diagnosis rather than another:

Disproportionate Pain

Far greater than the original injury would explain, often burning in quality.

Allodynia

Light touch — clothing, bedsheets, a breeze — registering as painful.

Colour and Temperature Change

The limb looking red, purple or mottled, and feeling hotter or colder than the other.

Swelling

Often fluctuating through the day.

Sweating and Hair or Nail Changes

Altered sweating, and changes in hair growth or nail texture.

Reduced Movement

Both from pain and from genuine stiffness developing.

Causes & Risk Factors

What Drives It

The usual contributors, in rough order of how often they turn out to matter:

01

Preceding Injury

Fracture, surgery or sprain in the great majority. Occasionally no trigger is identified.

02

Immobilisation

Prolonged casting or protection is a recognised contributor.

03

Altered Nervous System Processing

Both peripheral and central changes are involved.

04

Inflammatory Response

An exaggerated inflammatory response in the early phase.

How We Can Help You

Treatment & Management

Treatment is built around what the assessment finds, but generally follows this shape:

Early Recognition and Referral: Time matters here more than in almost any other MSK presentation.
Graded Movement: Keeping the limb moving, within tolerance, is central and should not be delayed.
Desensitisation: Graded exposure to touch and texture to reduce allodynia.
Mirror Therapy and Laterality Work: Well established in CRPS and worth doing properly.
Multidisciplinary Input: Pain medicine, occupational therapy and psychology alongside physiotherapy.

When to Seek Help

Red Flags — Don’t Ignore These

Most presentations are straightforward. These features are the exceptions, and warrant prompt assessment:

⚠ Seek Medical Advice If You Notice

  • Rapidly worsening pain, swelling or colour change after a fracture or surgery — seek prompt medical review
  • A limb that is cold, pale and pulseless — treat as an emergency
  • A tight cast with increasing pain
  • Signs of infection: fever, spreading redness or discharge

If any of these apply, contact your GP or seek urgent medical care rather than waiting for a physiotherapy appointment.

Common Questions

Frequently Asked Questions

Why does it hurt so much more than the injury should?

Because the pain system itself has become sensitised, and in CRPS that happens to a marked degree. The pain is real; it is simply no longer a reliable measure of tissue damage.

Should I rest it?

No. Protective immobilisation is one of the things that makes CRPS worse. Graded, tolerable movement from early on is a key part of treatment.

Will it resolve?

Many people improve substantially, particularly when treatment starts early. Longstanding CRPS is harder, which is exactly why recognition matters.

Not Sure If This Is What You Have?

An assessment will tell you what is actually going on and what to do about it. I see everyone myself, and you will leave with a plan rather than a leaflet.

Book Your Initial Assessment

This page is for general information only and isn’t a substitute for individual medical advice. If you’re experiencing any of the warning signs above, contact your GP or seek emergency medical care as appropriate.