Complex Regional Pain Syndrome

Complex Regional Pain Syndrome (CRPS) is a severe chronic pain condition that typically develops after a limb injury (fracture, surgery, sprain, or immobilisation) — but the pain is completely disproportionate to the original injury and persists or worsens long after the tissue should have healed. What distinguishes CRPS from ordinary pain: the burning, constant, severe pain that is described as "fire, electric, or acid being poured on the skin"; extreme sensitivity where even a light touch of clothing, a breeze, or water causes intense pain (allodynia); visible changes in the affected limb — skin colour changes (red, purple, mottled), temperature asymmetry (hot or cold compared to the opposite limb), swelling, sweating changes, and eventually changes in hair and nail growth; motor problems — weakness, tremor, and dystonic posturing; and the fact that the pain often spreads beyond the original injury area. CRPS is diagnosed using the Budapest Criteria and assessed by specialist pain physicians. SurgiPartner provides CRPS assessment in Hyderabad — call +91 9030053009.

CRPS requires a multidisciplinary treatment approach — no single treatment addresses all its mechanisms. The most evidence-based treatments are: (1) Graded physiotherapy with Graded Motor Imagery (GMI) — the most important long-term treatment; (2) Spinal cord stimulation (SCS) — the most effective interventional treatment for refractory CRPS, with Level I RCT evidence showing 60–75% significant pain reduction; (3) Sympathetic nerve blocks (stellate ganglion for upper limb, lumbar sympathetic chain for lower limb) — targeting the autonomic component and sympathetically-maintained pain; (4) Intravenous ketamine infusions — for severe acute CRPS; (5) Bisphosphonate infusions — for bone involvement; (6) Pharmacological management with gabapentinoids, amitriptyline, and topical agents. Early treatment (within the first 3 months) provides the best outcomes — SurgiPartner's pain specialists provide urgent CRPS assessment in Hyderabad. Call +91 9030053009 immediately if CRPS is suspected.

The stellate ganglion is a sympathetic nerve ganglion at the C7–T1 level in the neck that provides sympathetic innervation to the head, neck, arm, and hand. In upper limb CRPS, the coupling between sympathetic nerves and pain fibres (sympathetically-maintained pain) is a major driver of burning pain, colour changes, and temperature asymmetry in the affected arm. A stellate ganglion block delivers local anaesthetic to this ganglion under ultrasound or fluoroscopic guidance — interrupting sympathetic activity to the upper limb. If significant pain relief follows the block, sympathetically-maintained pain is confirmed as a major component, and the patient is a good candidate for more sustained sympatholysis (repeated blocks, RF ablation, or SCS). Stellate ganglion block also serves as a diagnostic test — patients with sympathetically-independent CRPS pain (limited or no response to the block) are better directed towards SCS rather than repeated sympathetic procedures. SurgiPartner performs stellate ganglion blocks for upper limb CRPS at partner centres in Hyderabad — call +91 9030053009.

CRPS can resolve completely, particularly when treated early and aggressively. Studies show that approximately 30–50% of patients with acute CRPS (within 3 months of onset) treated with comprehensive multimodal treatment achieve complete or near-complete resolution. For chronic CRPS (present for more than 12 months), complete cure is less common but significant improvement in pain, function, and quality of life is achievable for most patients with appropriate treatment. Children and adolescents with CRPS have a particularly good prognosis — recovery rates of 80–90% are reported with multidisciplinary treatment including intensive physiotherapy and psychological support. The key factors predicting good outcome: early treatment; absence of overt psychological comorbidity (severe depression, PTSD) at presentation; patient engagement with physiotherapy despite pain; and access to specialist multidisciplinary CRPS care. SurgiPartner provides urgent specialist CRPS assessment — call +91 9030053009 today.

Spinal cord stimulation (SCS) does not cure CRPS but significantly reduces pain and improves function — allowing patients to engage with rehabilitation and physiotherapy that would otherwise be impossible due to severe pain. The landmark Dutch RCT (Kemler et al.) showed that CRPS patients with SCS achieved significantly better pain reduction and quality of life at 2 years compared to those treated with physiotherapy alone. Long-term follow-up shows sustained benefit in many patients at 3–5 years. SCS works by delivering controlled electrical stimulation to the spinal cord's dorsal columns — replacing the painful sensation with paresthesia (tingling) and modulating the central sensitisation that drives CRPS pain. A 7–10 day trial stimulation period with an external generator confirms benefit before the permanent device is implanted. SCS is covered by health insurance in India for refractory CRPS. SurgiPartner's pain specialists assess CRPS patients for SCS candidacy — call +91 9030053009 for evaluation.

Yes — CRPS can spread from the originally affected limb to other parts of the body, though this is more common in severe, long-standing cases. Spread patterns: contiguous spread (extending proximally up the originally affected limb, e.g. from hand to arm and shoulder); mirror spread (development of CRPS features in the same limb on the opposite side of the body); and independent spread (new CRPS in a completely unrelated limb after a new injury or stress). Studies suggest approximately 20–35% of CRPS patients experience some degree of spread over 5 years. Spread is associated with: more severe central sensitisation; delayed or inadequate treatment; psychological distress; and immunological factors. Aggressive early treatment of the original CRPS — reducing central sensitisation as quickly as possible — is the best strategy for preventing spread. SurgiPartner's pain specialists monitor for and treat spreading CRPS — call +91 9030053009.

Graded Motor Imagery (GMI) is a three-stage physiotherapy programme that targets the cortical reorganisation and motor dysfunction of CRPS through specific brain training exercises: Stage 1 — Laterality Recognition: the patient is shown images of hands (or feet) in various positions and must rapidly identify whether the image shows a left or right limb; this activates motor cortex networks without causing movement or pain; Stage 2 — Imagined Movements: the patient vividly imagines moving the affected limb through increasingly complex movements without actually moving; Stage 3 — Mirror Visual Feedback: a mirror is placed so the reflection of the unaffected limb is perceived as the affected limb moving; the brain receives visual feedback of pain-free movement, gradually recalibrating its representation of the affected limb. The programme is delivered over 6+ weeks. Multiple RCTs demonstrate that GMI significantly reduces CRPS pain and improves movement beyond physiotherapy alone. SurgiPartner coordinates GMI physiotherapy alongside interventional pain procedures — call +91 9030053009.

Pharmacological treatment of CRPS in India: (1) Gabapentin (900–3,600mg/day) or pregabalin (150–600mg/day) — reduce central sensitisation and neuropathic pain; first-line. (2) Amitriptyline (10–75mg nightly) — reduces neuropathic pain and improves sleep. (3) Topical lidocaine patches — applied to allodynic areas; reduce touch-triggered pain. (4) Bisphosphonates — IV alendronate (7.5mg daily × 3 days) or pamidronate (30mg IV × 3 days) — significant pain reduction in RCTs; bone protection. (5) Calcitonin — nasal spray 200IU daily; analgesic and bone protective. (6) Vitamin C 500mg/day × 50 days — evidence for prevention of CRPS after wrist fracture. Standard NSAIDs provide minimal benefit; opioids have limited evidence and are not recommended for CRPS due to opioid-induced hyperalgesia risk. Corticosteroids (prednisolone 30–40mg/day tapering) may provide benefit in the acute inflammatory phase (first 3 months). All medications are best combined with physiotherapy. SurgiPartner's pain physicians optimise medication regimens for CRPS — call +91 9030053009.

CRPS is a clinical diagnosis using the Budapest Criteria — not a diagnosis of exclusion. Investigations support the diagnosis and exclude alternative conditions: (1) Three-phase bone scintigraphy (bone scan) — shows characteristic periarticular increased uptake in all three phases in acute CRPS; a normal bone scan does not exclude CRPS. (2) X-ray of the affected limb — periarticular osteoporosis (Sudeck's atrophy) in established CRPS. (3) MRI — periarticular marrow oedema; excludes other pathology. (4) Infrared thermometry — objectively quantifies skin temperature asymmetry between the affected and unaffected limb. (5) EMG/nerve conduction studies — confirm nerve injury in CRPS Type II; distinguish from peripheral nerve entrapment. (6) Sympathetic skin response and quantitative sensory testing (QST) — assess autonomic and sensory abnormalities. Diagnosis is made by an experienced pain specialist integrating clinical findings with investigations. SurgiPartner's pain team provides comprehensive CRPS assessment in Hyderabad — call +91 9030053009 urgently for early diagnosis and treatment.