Complex Regional Pain Syndrome

Complex Regional Pain Syndrome (CRPS) is a chronic pain condition that usually affects an arm, hand, leg or foot, often after an injury, fracture, sprain or surgery. The pain is typically more severe and longer-lasting than expected, and may be accompanied by swelling, colour or temperature changes, and increased sensitivity to touch.

CRPS can be distressing and disruptive, but early diagnosis and a structured treatment plan can help reduce symptoms, improve movement, and support daily function.

At the Royal Buckinghamshire Hospital, we provide consultant-led assessment and management planning, with rehabilitation-focused care and onward referral to specialist pain services where needed.

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Types of CRPS

CRPS is commonly described as:

• CRPS Type 1
  Occurs after an injury where there is no clear evidence of major nerve damage. This is the more common type.
• CRPS Type 2
  Occurs following a confirmed nerve injury (less common).

Both types can cause similar symptoms and require similar treatment approaches.

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Common Causes of CRPS

CRPS often develops after a trigger event, such as:

• A fracture (including wrist or ankle fractures)
• A sprain or soft tissue injury
• Surgery
• A period of immobilisation (such as a cast or splint)
• Nerve irritation or injury
• Sometimes, CRPS may develop after a relatively minor injury

CRPS is not fully understood. It is thought to involve changes in how the nervous system processes pain, along with altered inflammation and blood flow regulation in the affected limb.

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Symptoms of CRPS

Symptoms usually develop in the affected limb and can vary in intensity. Common symptoms include:

• Severe, persistent pain (burning, stabbing, throbbing or aching)
• Pain that feels out of proportion to the original injury
• Extreme sensitivity (even light touch, clothing or air movement can be painful)
• Swelling in the affected area
• Skin colour changes (red, blue, pale, blotchy)
• Temperature changes (the limb may feel unusually hot or cold)
• Sweating changes (more or less sweating than usual)
• Changes to skin texture (shiny, thin, dry, or unusually sensitive)
• Joint stiffness and reduced range of movement
• Weakness, tremor, or difficulty using the limb normally
• Changes in hair and nail growth
• Pain that may spread beyond the original area over time

Many people also experience reduced confidence using the limb, sleep disruption, fatigue, and the emotional impact of persistent pain.

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Diagnosis at Royal Buckinghamshire Hospital

CRPS is diagnosed through clinical assessment, based on your symptoms and a detailed examination. There is no single test that confirms CRPS on its own.

Your consultant may:

• Review your injury history, symptom timeline and how your symptoms have evolved
• Examine the limb for swelling, colour/temperature differences, sensitivity and movement changes
• Assess strength, coordination and functional impact
• Arrange tests (where appropriate) to rule out other causes of pain and swelling, such as infection, nerve compression, clotting issues, arthritis, or ongoing injury complications

Early recognition is important, particularly when symptoms include severe sensitivity, swelling, and movement avoidance after an injury or surgery.

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Treatment & Management

CRPS is usually managed best with a combined approach, focused on restoring function while reducing pain and sensitivity.

Pain management

Treatment may include medications used for nerve-related pain, alongside pain-relieving strategies tailored to your needs. Your clinician will explain options and adjust treatment based on benefit and side effects.

Physiotherapy and rehabilitation

Rehabilitation is often a core part of CRPS treatment and may include:

• Gentle graded movement and strengthening
• Improving range of motion and limb confidence
• Gradual return to normal activities
• Desensitisation techniques to reduce sensitivity over time

Occupational therapy support

Where needed, occupational therapy can help with:

• Hand and upper limb function
• Daily activity adaptations at home or work
• Pacing and flare-up management strategies

Psychological support (where appropriate)

Persistent pain can affect sleep, mood and stress levels. Psychological techniques can support recovery by helping you manage flare-ups, anxiety, fear of movement, and the overall impact of pain.

Specialist referral pathways

If symptoms are severe, persistent, or complex, your consultant may recommend referral to a specialist pain service for multidisciplinary support, which can include advanced pain management and longer-term rehabilitation planning.

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When to seek urgent help

Seek urgent medical advice if you experience:

• Sudden worsening pain with fever or feeling unwell
• Increasing redness, heat and swelling that could suggest infection
• New weakness, severe numbness, or inability to move the limb
• Significant swelling with breathlessness or chest pain
• Any rapidly progressing symptoms after injury or surgery

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If you’re experiencing persistent severe limb pain, swelling, sensitivity, or changes in colour/temperature following an injury or operation, contact Royal Buckinghamshire Hospital for assessment and guidance. There is no need to be registered with the hospital, or live locally.

If you have insurance which covers consultations, we can in most cases invoice the insurer directly. Where you are paying directly any costs will always be discussed.