Complex Regional Pain Syndrome (CRPS)

Complex regional pain syndrome (CRPS) is a condition of lasting intense pain in one or more body parts, most often an arm, leg, hand or foot. Most often, CRPS arises after an injury, but may also arise on its own. Pain is often severe and intense, well beyond what may be expected from the initial trauma.

The main symptom is long lasting, intense pain in the affected limb. The pain is often described as burning, throbbing, or squeezing sensation. Even things like light touch, clothing, or air on the skin can cause extreme pain.

Other changes in the body may occur with the pain include:

• Skin changes - The affected limb might look different. It could be red, purple, pale, or blotchy. It might feel hot and sweaty, or cold and clammy.
• Swelling – The arm, hand, leg, or foot may swell up and get worse with activity
• Joint stiffness – The arm, hand, leg, or foot can become stiff and difficult to move.
• Changes in hair or nail growth – The hair on the limb may grow faster or slower, and the nails might become brittle, ridged, or grow unusually fast.
• Difficulty in movement – May have trouble moving the limb or supporting body weight. It might tremble or jerk.

The cause is not known. CRPS is a form of neuropathic pain, meaning pain that comes from changes in the functioning of nerves. Sometimes symptoms start after an injury, such as a broken bone. Sometimes they occur after surgery. Limiting use of a body part, or not using it at all, can trigger this syndrome or make it worse.

A medical provider can diagnose CRPS primarily based on your child’s medical history and physical exam. There are no specific lab tests or imaging studies like X-rays that can be used to diagnosis this condition.

The most important treatment is working to regain function and normal sensation. The Pain Medicine Program will evaluate your child and then make specific treatment recommendations. This typically combines medical, physical and psychological rehabilitation strategies.

• Physical and Occupational therapy can help to desensitize the affected area. This is done to help the nerves start to respond more normally. To learn more, see our handout “Desensitization Techniques for Chronic Nerve Pain” (seattlechildrens.org/pdf/PE1717.pdf).
• Psychologists help patients learn to lessen the intensity of pain, cope with discomfort during rehabilitation exercises, and maintain gains achieved through rehabilitation.
• Medicines or nerve blocks are considered is specific cases.

We offer a Pain Rehabilitation Program (PReP) for youth who have not had success with outpatient pain treatment and those who need rehabilitation services in a more intensive setting. If this is recommended for your child, please see our handout “Pain Rehabilitation Program (PReP) – What to expect and how to prepare” (seattlechildrens.org/pdf/PE1950.pdf).