Specific conditions

What is Complex Regional Pain Syndrome (CRPS)?

Complex Regional Pain Syndrome (CRPS) is a type of inflammatory change that can happen in an arm or leg after injury. CRPS can sometimes happens on its own without a significant injury at all. CRPS doesn’t normally affect the whole body.

What are the symptoms of CRPS?

People normally develop an arm or leg that can be swollen, feel hot or cold compared to the other limb and often changes colour from time to time. They may describe having constant pain in the affected limb that may feel like ‘toothache’ or ‘electric shocks’. Their limb may be hypersensitive to touch in places and it may be too painful to wear clothing. They may be unable to use a knife or fork or write if it affects their hand or too painful to wear a sock or shoe if it affects their foot, particularly if its swollen.

What will happen to me if I get symptoms of CRPS?

Most people make a good recovery from CRPS and the vast majority are back to normal within a year or sooner.

What makes a difference is keeping using the arm or leg as much as normal during the time of recovery which may take several months. Quite a few conditions can produce the same type of symptoms as CRPS however so:

• The first step with suspected CRPS is a medical assessment and screening process to make sure the limb is not infected, does not have a clot in blood vessels or any other ongoing problem with damage to tissues or bones, particularly after an accident or some other problem with the brain or nerves is causing the CRPS symptoms. This can normally be done quite quickly. Once other conditions have been excluded or treated, it is possible to make diagnosis of CRPS.

• The second step is supported rehabilitation. Many people when they have a very painful arm or leg will tend not to want to use the limb until it recovers, but with CRPS people make a better recovery if they carry on using their arm or leg as much as normal, until symptoms improve. It has been found that immobilising the limb, for example in a plaster or sling for a long time can make things worse not better.

  CRPS impacts on how the brain perceives the limb, not just the limb itself. Often people feel like their arm of leg feels strange to them or different, and they may struggle if they shut their eyes for example to know quite what position the limb is in showing some of the disrupting that happens to the nervous system in the process.

  If it is recognised that you have CRPS, you may be advised to take painkillers and drugs for nerve pain, including topical nerve pain creams which can help palliate symptoms, but it is important not to delay rehabilitation while wating for complete pain relief from drugs, as this may be not be the case. Drugs do not always take all the pain of CRPS away.

With CRPS people recover best by returning to normal use of the affected arm or leg under the supervision of a Physio or Occupational Therapist. This is safe to do so, even if it hurts to start with. Although this may feel counter-intuitive using an arm or leg that is sore to use, it is the experience of the clinicians looking after you that this is the best way to help yourself recover and they will not suggest any activity that you cannot safely do.

Sometimes recovery in CRPS people find there are steps forwards and sometimes backwards which can be disheartening, but as long as the trend over time is in the right direction the team can teach you to mange any setbacks.

Can we prevent CRPS from happening?

There is some evidence taking Vitamin C can help prevent CRPS from occurring if taken right from the start of the injury. In South Devon it is recommended people with arm or leg fractures take Vitamin C 500mg for 50 days after their injury to help lower this of developing this condition and this information is in the information given out in fracture clinic.

Also see our information leaflet: Cast Care Advice for Patients, Relatives and Carers

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