The Complex Regional Pain Syndrome (CRPS) is a rare disease of the nervous system that causes intense and prolonged pain in a part of the body (usually a hand, an arm, a foot, or a leg) after an injury, surgery, or even just after minor trauma (such as a sprain or fracture).
In CRPS Type I, there is no visible direct nerve injury. Despite this, an abnormal reaction of the nervous system and local inflammation develops.
Why Does it Develop?
It is not yet completely clear why some people develop CRPS. Research suggests that several factors are involved:
- Alteration of the autonomic nervous system (which controls sweating, temperature, heart rate, etc.)
- Abnormal local inflammation that persists over time
- Hyperactivation of sensory nerves, which become overly sensitive
- Modifications of the central nervous system (the brain misinterprets pain signals)
In other words: it is as if the body does not “turn off” the pain alarm, even though the initial injury has healed.
What are the Symptoms?
CRPS usually manifests within 4-6 weeks of trauma or surgery. Symptoms vary over time and from person to person:
- Very intense pain, burning or stabbing, disproportionate to the initial cause
- Red, cold, or hot skin, sometimes with abnormal sweating
- Persistent swelling of the limb
- Weakness and difficulty moving the affected part
- Hyperesthesia: even a light touch can cause pain
- Changes in nails and hair (slow growth, brittle nails)
- In advanced stages: joint stiffness, loss of muscle mass, contractures
How is the Diagnosis Made?
The diagnosis is based on the Budapest Criteria, a set of clinical signs and symptoms. There are no specific blood tests. Sometimes supportive examinations are used to exclude other pathologies:
- Magnetic resonance imaging or bone scintigraphy
- Neurological evaluation
It is important to receive an early diagnosis, as treatment is more successful in the initial stages.
How is it Treated?
Multimodal Treatment: the most Effective Method
CRPS has no definitive cure, but can improve or stabilize with targeted, early, and multidisciplinary treatment.
- Medications:
- Anti-inflammatory drugs (in the early stages)
- Antidepressants and anticonvulsants for neuropathic pain (e.g., amitriptyline, gabapentin, pregabalin)
- Corticosteroids in acute phases
- 50% topical DMSO (in selected cases)
- Physical therapy:
- Gentle and progressive mobilization of the limb
- Desensitization (to reduce hypersensitivity)
- Occupational therapy to promote daily autonomy
- Psychological support:
- To help cope with chronic pain, stress, and fear of movement
- Interventional therapies (in resistant cases):
- Sympathetic blocks (injections near autonomic nervous system nerves)
- In some selected and resistant cases, low-dose intravenous ketamine infusions may be considered, under specialist monitoring
- Neuromodulation (spinal stimulation in selected cases)
The Importance of Collaboration
Treatment success depends on teamwork between:
- Pain medicine physician
- Physical therapist
- Clinical psychologist
- Possible orthopedic or neurological specialists
What is the Prognosis?
CRPS can be a complex condition, but many patients show improvement over time, especially if the diagnosis is early and treatment is personalized. In some cases, pain may persist longer, but even in these situations, targeted therapies and strategies exist to improve quality of life.
