Complex Regional Pain Syndrome (CRPS) Info Evidence

What you're feeling

You may notice pain that feels different from a normal ache. It often starts in one hand, arm, foot, or leg. The pain can feel like burning, throbbing, or stabbing. You might feel sensitive to touch or temperature changes. Even light clothing or a gentle breeze can feel uncomfortable. This happens because your nerves are sending mixed signals to your brain.

The pain often gets worse at night. It may also flare up after you have been active during the day. When you first wake up, your limb might feel stiff or swollen. This stiffness can make simple tasks difficult. You might struggle to reach behind your back to fasten a bra. Tucking in a shirt or buttoning a jacket can feel awkward and painful. Lifting objects or gripping things may become hard to do.

Sleeping on the affected side is often not possible. You might find yourself changing positions frequently to find relief. The discomfort can interfere with your daily routine and rest. While early treatment helps reduce the risk of permanent loss of function, some people still experience lasting changes. Your surgeon will work with you to manage these symptoms. Understanding what you are feeling is the first step toward better care.

What's actually happening

CRPS is a complex condition where your body’s pain signals get stuck in the "on" position. It is not just a simple injury. Instead, it is a multifactorial issue involving your nerves, immune system, and even your genetics. Your surgeon diagnoses this based on your history and physical exam, looking for specific signs that tell us what is going wrong inside your tissues.

Think of your nerves as electrical wires that have short-circuited. Tests show that the way you feel pain is fundamentally altered compared to people without this condition. Your brain and nerves are misinterpreting normal signals as severe pain. This is why standard painkillers often do not work well enough on their own.

Because the problem involves so many different systems, there is no single fix. Early recognition is critical. If we catch this early, we can use active treatments to lower the risk of it becoming a long-term issue. However, even with prompt care, some patients may still experience permanent changes in how their limb functions.

The symptoms you feel—such as swelling, color changes, or extreme sensitivity—are the result of this nerve confusion. Your body is reacting to a perceived threat that isn't there. This is why we use tools like the Hamilton Inventory to track not just your pain, but also how it affects your daily life and mental well-being.

While the exact cause remains under study, we know that ignoring it can lead to permanent loss of function. That is why we take a comprehensive approach. We might use medications like ketamine or prednisolone to calm the nerves. We may also use high-intensity laser therapy to reduce pain directly at the site. These treatments aim to break the cycle of pain before it becomes permanent.

What to expect

Your surgeon will diagnose this condition based on your history and a physical exam. Early recognition and prompt treatment are important to minimize permanent loss of function. However, even with care, you may still experience permanent impairment and disability. The condition is multifactorial, meaning many factors are involved, and researchers are still studying exactly how it develops.

If left alone, the outlook is uncertain. An active treatment approach appears to lower the risk of developing the most common form of this syndrome. For those who already have chronic or difficult-to-treat symptoms, strong consideration should be given for the use of ketamine. Other options include prednisolone, which may be used in settings where specialized interventions are unavailable. High-intensity laser therapy also provides conclusive evidence of pain reduction, even after just the third treatment session.

Recovery feels different for everyone. You might notice pain changes within weeks of starting therapies like laser treatment. Quantitative sensory testing shows that your pain mechanisms are altered compared to healthy controls, which helps explain why standard tests might not fully capture your experience. Tools like the Hamilton Inventory help track your symptoms, functional limits, and how the condition affects your daily life.

While some cases resolve, others persist. The incidence of this syndrome following isolated cubital tunnel surgery is exceedingly rare, with an overall one-year incidence rate of approximately 0.33%. For wrist fractures, the reported incidence within four months varies depending on diagnostic criteria and how the fracture was managed. Because the methodological quality of non-drug treatments for upper limb cases is often poor, your surgeon will tailor a plan based on what works for you. Be honest about your progress. Realistic expectations help you manage the condition without false promises.

Complex Regional Pain Syndrome (CRPS) Info Evidence

What you're feeling

What's actually happening

What to expect

Overview

Background & Causes

Symptoms & Presentation

Management

Key Considerations

Key Evidence

References