ਕੰਪਲੈਕਸ ਰੀਜਨਲ ਪੇਨ ਸਿੰਡਰੋਮ (ਸੀਆਰਪੀਐਸ) ਜਾਣਕਾਰੀ

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

• CRPS is a multifactorial condition that requires further study to better understand its pathogenesis, epidemiology, genetic involvement, psychological implications, and treatment options [3].
• The diagnosis of CRPS is a clinical diagnosis based on history and physical examination [9].
• Early recognition and prompt treatment of CRPS are important to minimize permanent loss of function [9].
• Patients with CRPS may still experience permanent impairment and disability despite early recognition and prompt treatment [9].
• Quantitative sensory testing outcomes indicate altered pain mechanisms in complex regional pain syndrome compared to controls, with a pooled standardized mean difference of -0.41 [5].
• The reported incidence of CRPS is influenced by the choice of diagnostic criteria, study location, and how the fracture is managed [15].
• A more active treatment approach seems to lower the incidence of CRPS-1 following distal radius fracture [2].
• CRPS following isolated cubital tunnel surgery is exceedingly rare, with an overall 1-year incidence rate of approximately 0.33% [10].
• The Hamilton Inventory can be relied upon to assess CRPS symptoms, functional limitations, and psychosocial impacts [4].

Background & Causes

Pathophysiology and Diagnosis

• Quantitative sensory testing outcomes indicate altered pain mechanisms in CRPS compared to controls, with a pooled standardized mean difference of -0.41 [5].
• Early recognition and prompt treatment are important to minimize permanent loss of function, though patients may still experience permanent impairment and disability [9].

Risk Factors and Incidence

• Female sex and release of more than one digit are significant predictors of developing CRPS following treatment of Dupuytren contracture [11].
• Elderly patients, females, and manual laborers have higher risks of developing CRPS after distal radius fracture surgery [13].
• Preexisting neuropathic disorders, particularly traumatic nerve injuries, compressive neuropathies, and cervical radiculopathy, are the strongest predictors of CRPS after distal radius fracture [17].
• Patients suffering from scaphoid waist fracture may be at a higher risk of CRPS I, especially in women with diabetes mellitus who report severe pain before treatment [20].
• CRPS-related hand lesions developed in 19.4% of patients following arthroscopic rotator cuff repair [14].

Modifiable Factors and Management Implications

Symptoms & Presentation

• CRPS is a multifactorial condition [3].
• Pain is a highly debilitating symptom in CRPS-I [7].
• Patients with CRPS may experience permanent impairment and disability [9].
• Glomus tumors should be included in the differential diagnosis for patients with unusual chronic pain or neuropathy [19].
• The diagnosis of CRPS should only be a diagnosis of exclusion [19].

Management

Pharmacologic

• In patients presenting with chronic or refractory CRPS, strong consideration should be given for the use of ketamine [1].
• Prednisolone is a potential treatment option for CRPS, particularly in resource-limited settings where more specialized interventions may be unavailable [6].
• Topical application of doxepin may represent a simple option for the management of CRPS [18].

Non-Pharmacologic

• A more active treatment approach seems to lower the incidence of CRPS-1 [2].
• High-intensity laser therapy and mirror therapy provide conclusive evidence of pain reduction in CRPS-I, even after the third HILT treatment session [7].
• The methodological quality of non-pharmacological treatment approaches for upper limb CRPS is overall poor [8].

Operative

• A large percentage of patients diagnosed with and treated for CRPS type 1 can have full resolution of their symptoms with carpal tunnel release [12].
• The positive outcome for a patient with Dupuytren's and CRPS-I after collagenase clostridium histolyticum injection is encouraging [16].

Assessment and Prognosis

• Early recognition and prompt treatment are important to minimize permanent loss of function in CRPS [9].

Key Considerations

Diagnosis and Pathophysiology

• The reported incidence of CRPS is influenced by choice of diagnostic criteria, along with the study location and/or how the fracture is managed [15].

Risk Factors and Incidence

Treatment

• High-intensity laser therapy and mirror therapy offer conclusive evidence of pain reduction in CRPS-I, even after the third treatment session [7].
• A positive outcome was observed for a patient with Dupuytren's contracture and CRPS-I after collagenase clostridium histolyticum injection [16].

Prognosis and Assessment

Key Evidence

• [L1] In patients presenting with chronic or refractory CRPS, strong consideration should be given for the use of ketamine. [1] (10.1177/15589447221131847)
• [L3] A more active treatment approach seems to lower the incidence of CRPS-1. [2] (10.1177/1558944719895782)
• [L4] CRPS is a multifactorial condition that still requires further studying to better understand its pathogenesis, epidemiology, genetic involvement, psychological implications, and treatment options. [3] (10.1007/s40122-021-00279-4)
• [L4] It can be relied upon to assess CRPS symptoms, functional limitations, and psychosocial impacts. [4] (10.1016/j.jht.2025.02.004)
• [L1] The systematic review and meta-analysis of quantitative sensory testing outcomes indicates altered pain mechanisms in complex regional pain syndrome compared to controls, with a pooled standardized mean difference of -0.41. [5] (10.1186/s13018-022-03461-2)
• [L4] The report emphasizes the importance of recognizing CRPS and highlights the potential of prednisolone as a treatment option, particularly in resource-limited settings where more specialized interventions may be unavailable. [6] (10.1186/s12891-024-07333-0)
• [L1] The study results offer conclusive evidence of pain reduction, a highly debilitating symptom in CRPS-I, even after the third HILT treatment session. [7] (10.1016/j.jht.2025.02.009)
• [L1] Methodological quality of non-pharmacological treatment approaches for upper limb CRPS is overall poor. [8] (10.1177/17589983221138610)
• [L2] CRPS following isolated CuTS is exceedingly rare, with an overall 1-year incidence rate of approximately 0.33%. [10] (10.1016/j.jhsg.2026.101028)
• [L3] Female sex and release of more than one digit are significant predictors of developing CRPS. [11] (10.1177/1558944720963915)
• [L3] This study demonstrates that a large percentage of patients diagnosed with and treated for CRPS type 1 can have full resolution of their symptoms with carpal tunnel release. [12] (10.1016/j.jhsa.2024.09.024)
• [L3] The occurrence of CRPS is the result of many factors, with elderly patients, females, and manual laborers having higher risks. [13] (10.1186/s12891-024-07948-3)
• [L3] CRPS-related hand lesions developed in 19.4% of patients following ARCR. [14] (10.5397/cise.2021.00080)
• [L1] The reported incidence of CRPS is influenced by choice of diagnostic criteria, along with the study location and/or how the fracture is managed. [15] (10.1177/1758998320910179)
• [L4] The positive outcome for this woman with Dupuytren's and CRPS-I after CCH injection is encouraging. [16] (10.1016/j.jht.2024.09.002)
• [L3] Preexisting neuropathic disorders, particularly traumatic nerve injuries, compressive neuropathies, and cervical radiculopathy, are the strongest predictors of CRPS after distal radius fracture. [17] (10.1016/j.jhsa.2026.01.004)
• [L5] This case report suggests that the topical application of doxepin may represent a simple option for the management of CRPS. [18] (10.1016/s0020-1383(01)00054-7)
• [Case_report] Glomus tumors should be included in the differential diagnosis for patients with unusual chronic pain or neuropathy, and the diagnosis of CRPS should only be a diagnosis of exclusion. [19] (10.1177/1558944719895618)
• [L2] Patients suffering from scaphoid waist fracture may be at a higher risk of CRPS I, especially in women with diabetes mellitus who report severe pain before treatment. [20] (10.1186/s12891-021-04977-0)

References

[1] Pharmacologic Treatments in Upper Extremity Complex Regional Pain Syndrome: A Review and Analysis of Quality of Evidence. HAND. 2022. DOI: 10.1177/15589447221131847

[2] Treatment of Distal Radius Fracture: Does Early Activity Postinjury Lead to a Lower Incidence of Complex Regional Pain Syndrome?. HAND. 2020. DOI: 10.1177/1558944719895782

[3] Complex Regional Pain Syndrome: A Comprehensive Review. Pain and Therapy. 2021. DOI: 10.1007/s40122-021-00279-4

[4] Psychometric evaluation of the Hamilton Inventory to evaluate signs and symptoms in patients with Complex Regional Pain Syndrome (CRPS). Journal of Hand Therapy. 2025. DOI: 10.1016/j.jht.2025.02.004

[5] Pain mechanisms in complex regional pain syndrome: a systematic review and meta-analysis of quantitative sensory testing outcomes. Journal of Orthopaedic Surgery and Research. 2023. DOI: 10.1186/s13018-022-03461-2

[6] Complex regional pain syndrome: diagnostic challenges and favorable response to prednisolone. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-024-07333-0

[7] Effect of high-intensity laser therapy and mirror therapy on complex regional pain syndrome type I in the hand area: A randomized controlled trial. Journal of Hand Therapy. 2025. DOI: 10.1016/j.jht.2025.02.009

[8] Person-centred management of upper limb complex regional pain syndrome: an integrative review of non-pharmacological treatment. Hand Therapy. 2023. DOI: 10.1177/17589983221138610

[9] Complex Regional Pain Syndrome. 2021.

[10] Incidence and Patient-Level Risk Factors for Complex Regional Pain Syndrome Following Cubital Tunnel Surgery. Journal of Hand Surgery Global Online. 2026. DOI: 10.1016/j.jhsg.2026.101028

[11] Separating Fact From Fiction: A Nationwide Longitudinal Examination of Complex Regional Pain Syndrome Following Treatment of Dupuytren Contracture. HAND. 2020. DOI: 10.1177/1558944720963915

[12] Outcomes of Median Nerve Release in Complex Regional Pain Syndrome Type 1 of the Hand: A Prospective Case Series. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2024.09.024

[13] Dynamic risk factors for complex regional pain syndrome after distal radius fracture surgery: multivariate analysis and prediction. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-024-07948-3

[14] Clinical outcome in patients with hand lesions associated with complex regional pain syndrome after arthroscopic rotator cuff repair. Clinics in Shoulder and Elbow. 2021. DOI: 10.5397/cise.2021.00080

[15] What is the incidence of complex regional pain syndrome (CRPS) Type I within four months of a wrist fracture in the adult population? A systematic review. Hand Therapy. 2020. DOI: 10.1177/1758998320910179

[16] The case of a woman with bilateral Dupuytren’s contractures who developed CRPS-1 after fasciectomy with no relapse on subsequent collagenase clostridium histolyticum injection and manipulation of the other hand: Considerations for implementing a Budapest criteria checklist and assessing vasomotor instability by measuring differences in skin temperature. Journal of Hand Therapy. 2025. DOI: 10.1016/j.jht.2024.09.002

[17] A Nationwide Propensity Score-Matched Analysis Identifying Preinjury Predictors of Complex Regional Pain Syndrome Following Distal Radius Fracture. The Journal of Hand Surgery. 2026. DOI: 10.1016/j.jhsa.2026.01.004

[18] Topical application of doxepin hydrochloride can reduce the symptoms of complex regional pain syndrome: a case report. Injury. 2002. DOI: 10.1016/s0020-1383(01)00054-7

[19] An Unusual Case of Periosteal Glomus Tumor at the Metacarpal Base Presenting as Type II CRPS: Case Report. HAND. 2020. DOI: 10.1177/1558944719895618

[20] Determinants of complex regional pain syndrome type I in patients with scaphoid waist fracture- a multicenter prospective observational study. BMC Musculoskeletal Disorders. 2022. DOI: 10.1186/s12891-021-04977-0