Is CRPS 'all in my head'?

No. CRPS involves measurable changes in the nervous system, blood vessels, immune activity, and skin. The pain is real and physical. Psychological factors such as fear of moving the limb can influence how it progresses, which is why psychological support is part of treatment, but that does not mean the condition is imagined.

Outcomes vary widely. Many people, particularly those diagnosed and treated within the first few months, improve substantially or recover. Others develop long-term pain and disability. Early active rehabilitation is the strongest predictor of a good outcome, so prompt diagnosis matters.

Should I rest the limb to protect it?

Resting feels natural because movement hurts, but prolonged immobility worsens CRPS by increasing stiffness, swelling, and the brain's sense that the limb is under threat. Guided, gradual use of the limb, even when uncomfortable, is central to recovery. A physiotherapist experienced in CRPS can help you find the right pace.

NeurologicalICD-10: G90.5Rare; most often follows fractures or surgery and affects women more than men

Complex Regional Pain Syndrome

Also known as: CRPS, Reflex sympathetic dystrophy, Causalgia

Complex regional pain syndrome (CRPS) is a chronic pain condition that usually develops in an arm or leg after an injury, fracture, surgery, or period of immobilization. The pain is far more severe and long-lasting than the original injury would explain, and it comes with changes in the skin: swelling, color and temperature differences, altered sweating, and extreme sensitivity so that even light touch or a breeze can be agonizing. CRPS is thought to involve an abnormal, exaggerated response of the nervous and immune systems to injury rather than ongoing tissue damage. It is poorly understood and can be very disabling, but early diagnosis and a combination of rehabilitation, medication, and psychological support offer the best chance of recovery.

At a Glance

Common symptoms: Continuous burning, throbbing, or stabbing pain out of proportion to the injury, Extreme sensitivity to touch, cold, or pressure (allodynia), Swelling of the affected limb
Main treatments: Early, active physiotherapy and occupational therapy to keep the limb moving and restore function, Pain medications including nerve-pain drugs (gabapentinoids, tricyclics), anti-inflammatories, and short courses of corticosteroids early on, Bisphosphonates in some early cases, and other medications under specialist guidance
Category: Neurological · Rare; most often follows fractures or surgery and affects women more than men
See a doctor if: Pain after an injury that is worsening or far more intense than expected

Symptoms

Continuous burning, throbbing, or stabbing pain out of proportion to the injury

Extreme sensitivity to touch, cold, or pressure (allodynia)

Swelling of the affected limb

Changes in skin color (blotchy, red, blue, or pale) and temperature compared with the other side

Abnormal sweating, and changes in hair and nail growth

Stiffness, weakness, tremor, or difficulty moving the limb

Thin, shiny skin and muscle wasting in long-standing cases

Causes

Trauma such as a fracture, sprain, crush injury, or surgery (most cases)
Prolonged immobilization in a cast or splint
Injury to a nerve (CRPS type II)
Abnormal inflammatory and immune responses after injury
Changes in how the spinal cord and brain process pain signals (central sensitization)
Dysregulation of the sympathetic nervous system affecting blood flow and sweating

Risk Factors

Fracture, particularly of the wrist or ankle
Female sex and middle age
Tight casts or prolonged immobilization after injury
Severe pain in the early period after injury
Possible genetic susceptibility

Diagnosis

Clinical diagnosis using established criteria (the Budapest criteria) based on symptoms and signs
Examination comparing the affected and unaffected limbs for temperature, color, swelling, and sensitivity
Tests to exclude other causes such as infection, blood clot, nerve entrapment, or arthritis
X-rays, bone scan, or MRI may support the diagnosis but cannot confirm it alone
Nerve conduction studies if nerve injury (type II) is suspected

Treatment

Early, active physiotherapy and occupational therapy to keep the limb moving and restore function
Pain medications including nerve-pain drugs (gabapentinoids, tricyclics), anti-inflammatories, and short courses of corticosteroids early on
Bisphosphonates in some early cases, and other medications under specialist guidance
Psychological therapies such as CBT to manage pain, fear of movement, and the emotional impact
Specialist pain-clinic interventions such as nerve blocks or spinal cord stimulation for severe, persistent cases
Supportive: graded motor imagery and mirror therapy, which retrain the brain's map of the limb
Supportive: desensitization techniques, gentle use of the limb in daily tasks, and pacing of activity

Prevention

Start gentle movement early after injury or surgery, as advised by your clinician
Report a cast that feels too tight or pain that is escalating rather than settling
Some evidence supports vitamin C after wrist fractures to lower CRPS risk, though findings are mixed
Control pain well in the early period after injury
Avoid prolonged, unnecessary immobilization

When to See a Doctor

Pain after an injury that is worsening or far more intense than expected
Swelling, color, or temperature changes in a limb after injury
Skin so sensitive that clothing or light touch is painful
Loss of movement or function in the affected limb
A limb that is hot, red, and swollen with fever (seek urgent care to rule out infection or clot)

Frequently Asked Questions

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Frozen Shoulder

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