What is CRPS?
Complex Regional Pain Syndrome (CRPS) is a condition which causes pain in an arm or leg. It usually develops after an injury, but the pain is more severe and lasts much longer than would be usually expected from the injury itself. CRPS type I follows an injury such as a fracture or sprain, but with no nerve damage. It can also sometimes occur spontaneously, without any obvious trigger. CRPS type II follows damage to a nerve in the limb.
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Children and adults of all ages can develop CRPS. It is most commonly found in hands and wrists, feet and ankles, or knees. In some people, the whole limb (or more than one limb) can be affected. Pain is the main symptom, which is often described as a burning or stabbing sensation. The affected limb can be swollen and very sensitive to touch. There may be temperature or colour changes. A reduction in limb function means that everyday tasks (e.g. dressing or preparing a meal) can become very difficult for some people. ​
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There is no specific test that will confirm a diagnosis of CRPS, but scans and blood tests can help to rule out other conditions. The Budapest criteria, adopted by the International Association for the Study of Pain (IASP) in 2004, has become the globally recognised list of signs and symptoms to aid diagnosis. The Valencia consensus-based adaptation of the Budapest criteria was published in 2021, incorporating updates to the assessment instructions and associated text. Treatment for CRPS is usually a combination of physical rehabilitation therapy and pain-relieving medication. Psychological therapies may be offered, in addition to advice on self-managing the condition. Prompt diagnosis and treatment is best practice, but treatment can be beneficial at any stage.
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What should I do if I think I have CRPS?
CRPS can present with a number of symptoms affecting the limb. These features are shared with a number of other conditions and it is therefore very important to get the diagnosis confirmed. Your GP or fracture clinic may refer you to other specialties for this confirmation - such as orthopaedics, rheumatology, pain services or neurology.
How long will CRPS last?
Most people recover well within a year. However, some people continue to experience symptoms for much longer.
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Will I get CRPS again if I have another injury?
There is no evidence that a previous episode of CRPS is a risk factor for further episodes. It is important to try to keep moving and use your limb as normally as possible.
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Is there anything else that I or my GP can do to help?
There are national guidelines to help health professionals access the best advice and treatment for you. Your GP may not have seen many people with CRPS and it can be helpful to mention the guidelines to them.
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Should I use my limb if it hurts?
It is perfectly normal to try and avoid pain by stopping an aggravating activity or moving in a way which makes it more comfortable. Unfortunately, over time our body adapts to this abnormal movement and altered function in an unhelpful way. The musculoskeletal system is affected: some muscles become weak, whilst others become overused and tight, bones may become weaker. Our nervous system is affected; some nerves become over-sensitive, nerves become tight, our ability to initiate and control movement may become affected. There can also be changes in your brain, which lead to you feeling differently about your painful limb, or feeling as though it is not a part of you. These changes can all drive your pain condition and exacerbate your symptoms, leading to an unhelpful cycle. By trying to move your limb and moving as normally as possible, even when it is painful, you will be helping to reduce the changes listed above. You should be mindful of maintaining good quality movement, either when performing an exercise, a functional task during the day, or simply when walking. Using breathing and relaxation techniques can help you to do this more effectively.
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How can I use aids to make daily activities easier?
People often ask for advice on using daily living aids to help manage tasks more easily. It is important to use these aids in a way which will make it easier for you to involve your limb in a task. It can be tempting to use an aid rather than involving your limb - for example, doing tasks one handed, or avoiding putting weight through both of your lower limbs. However, involving your limbs in daily tasks despite pain is essential for managing CRPS effectively. The range of daily living aids and equipment can often seem overwhelming. We recommend an assessment by an Occupational Therapist, who can be accessed via your GP or local council. Talk to your Occupational Therapist about the importance of using aids to help you to continue using your affected limb in tasks, or be mindful of this should you choose to purchase your equipment privately.
Does CRPS run in families?
There is no clear evidence that CRPS runs in families.
Does CRPS affect pregnancy?
Published literature suggests that there is no evidence of CRPS itself affecting pregnancy or being affected by it. Some medicines used to treat CRPS can be harmful to a developing baby, so it is essential to discuss family planning with your doctor. It is also important to discuss with your doctor or midwife about any support you may need during delivery or after the baby is born.
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Does CRPS cause increased sensitivity to the sun?
There is no evidence of this, so the best advice is to follow general sun safety guidelines. Use sunscreen with a sun protection factor (SPF) of at least 30 - the higher the SPF, the better. Reapply sunscreen regularly and after being in water. Try and spend time in the shade during the hottest part of the day (between 11am and 3pm), and cover your skin if possible.
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What is the law relating to medications and driving?
It is an offence in England and Wales to drive with certain drugs above specified blood levels in the body, whether your driving is impaired or not. This law includes higher limit levels of morphine or opiate based medications. If you are unsure how this affects you, talk to your GP or pharmacist.