What CRPS is and how it presents
Complex regional pain syndrome is a debilitating condition that typically develops after an injury (fracture, surgery, sprain) but produces pain and symptoms disproportionate to the initial injury. CRPS most commonly affects an arm or leg, though it can occur in other body regions. The condition is characterised by regional pain, sensory changes, autonomic dysfunction, and motor impairment.
CRPS is classified into two types: CRPS-I (formerly reflex sympathetic dystrophy) occurs without identifiable nerve injury; CRPS-II (formerly causalgia) occurs with confirmed nerve injury. Both types share similar clinical features. The Budapest diagnostic criteria require continuing pain disproportionate to inciting event, plus at least one symptom in three of four categories (sensory, vasomotor, sudomotor/edema, motor/trophic) and at least one sign in two categories at evaluation.
- Severe pain disproportionate to initial injury
- Sensory changes � hyperalgesia, allodynia
- Vasomotor changes � skin temperature, colour asymmetry
- Sudomotor/edema � sweating, swelling changes
- Motor/trophic changes � weakness, decreased range of motion, trophic changes
Related: Neuropathy Treatment → · Dr. Jitendra Knowledge Hub → · ICHD-3 Topic →
Treatment approaches
Early treatment is critical for better outcomes. Physiotherapy is the cornerstone of CRPS management � graded mobilisation, desensitisation techniques, and range-of-motion exercises prevent stiffness and improve function. Pain management includes medications targeting neuropathic pain (gabapentin, pregabalin, duloxetine, amitriptyline) and anti-inflammatory agents. Bisphosphonates may be helpful in early CRPS.
Interventional procedures may include sympathetic nerve blocks, spinal cord stimulation, or intrathecal drug delivery for refractory cases. Psychological support addresses the depression, anxiety, and sleep disturbance that commonly accompany chronic pain. The goal is pain reduction, functional improvement, and prevention of contractures. Dr. Jitendra Prasad Yadav (NMC 8029) provides CRPS evaluation and coordinates multidisciplinary care at Kathmandu Neurology Clinic, Durbar Marg, Opposite of Yak & Yeti Hotel.
| Treatment Modality | Purpose | Timing |
|---|---|---|
| Physiotherapy | Prevent stiffness, improve function | Early and ongoing |
| Neuropathic pain medications | Reduce pain intensity | Early initiation |
| Sympathetic nerve blocks | Diagnostic and therapeutic | When sympathetic involvement suspected |
| Spinal cord stimulation | Refractory pain management | When conservative measures inadequate |