Visit our Location
250 Main Street, New York
Give us a Call
+ (12) 123 - 556 - 7890
Send us a Message
Opening Hours
Mon - Friday: 8AM - 5PM

About CRPS

What Is CRPS

Complex regional pain syndrome (CRPS) is a chronic pain condition which, as its name suggests, is very complex and it is most likely to affect a single limb. It is classified into CRPS-1, and CRPS-2. CRPS symptoms include

  • burning pain,
  • allodynia (pain from a non-painful stimulus such as touch) and hyperalgesia (increased response to a painful stimulus)
  • motor disturbances
  • tremor and muscle spasms
  • changes in vascular tone, temperature, skin colour, sweating and oedema, and
  • changes to skin, hair, nails and perceptual disturbances with distortions to the body-self.

CRPS-1 can occur spontaneously or following trauma, with the symptoms unrelated to the region of a single nerve, and unequal to the event. CRPS-2 occurs in association with nerve damage.

Cause Of CRPS

Very little is known about the aetiology of CRPS. The initial cause may be a strain or minor tissue injury that develops into this complex, abnormal health problem. Secondary symptoms can then develop including signs from the somatosensory nervous system, the neuromuscular-system, and the autonomic nervous system which creates a confusing picture.

It was originally proposed that the Sympathetic Nervous System (SNS) was the main driver for CRPS symptoms, hence the old name Reflex Sympathetic Dystrophy (RSD). However, it is now believed that the SNS is not the sole cause of CRPS, as sympathetic nerve blocks did not provide significant relief from the pain. If it had been caused by the SNS, a sympathetic nerve block should stop the pain.

Based on many physiological and functional imaging studies there is significant evidence that in chronic pain, reorganisation of the primary somatosensory cortex, the secondary somatosensory cortex, and the motor cortex can occur. It has been demonstrated that the degree of reorganisation is directly related to the intensity of CRPS pain.

One theory about why the reorganisation may happen is that pain leads to “protective disuse”. You may not want to move the limb as you are worried it may hurt. This anticipation of pain can become a learned reaction and you may produce pain on just thinking about movement. The “protective disuse” can also lead to a smaller representation of that limb in the brain. Pain can therefore be induced by a mismatch between proprioceptive feedback and motor action.

Another theory is neurogenic inflammation. This involves an increase of inflammatory mediators in the blood, which have been found in people with CRPS. It is thought that the elevation of these substances occurs because they continue to be active after their release, hence promote inflammation. Another suggestion is that more receptors are available to receive them. This results in some of the symptoms of CRPS such as increased temperature, skin reddening, oedema and increased pain responses.

CRPS treatment has proven very difficult due to the lack of understanding around it. Many different modalities have been used, including medical management (analgesics, steroids, supplements), interventional treatments (sympathetic nerve blocks, sympathectomy, amputation and spinal cord stimulator insertion) and physiotherapy (including mirror box therapy). Although approximately 150–200 techniques have been proposed for the treatment and prevention, it is still very difficult to treat.

Find Out More About Mirror Therapy For CRPS/RSD Here

< Return To Home | Mirror Therapy Box Rehab Kit >


Birklein F, Schmelz M (2008) Neuropeptides, neurogenic inflammation and complex regional pain syndrome (CRPS). Neuroscience Letters 437: 199-202.
Birklein F, Kingery WS (2009) Complex regional pain syndrome: A loss of inhibition? Pain 142: 177-178.
Cacchio, A, Blasis, E, Necozione, S, Santilli, V (2009) Mirror Therapy for Chronic Complex Regional Pain Syndrome Type 1 and Stroke The New England Journal of Medicine 361(6): 624-636
Flor H (2003) Cortical reorganisation and chronic pain: Implications forrehabilitation. Journal of Rehabilitative Medicine 41: 66-72.
Flor H and Diers M (2009) Sensiorimotor training and cortical reorganization. NeuroRehabilitation 25: 19-27.
Galer BS, Schwatz L and Allen G (2001) Complex Regional Pain Syndromes- Type I: Reflex Sympathetic Dystrophy, and Type II: Causalgia. In Loeser JD, Butler SH, Chapman MD, Richard C, Dennis C and Turk DC (Eds) Bonica’s Management of Pain (3rd edn). Philadelphia: Lippincott Williams and Wilkins, pp 388-411.
Galer BS, Jensen M, Butler S. (2013) Neglect-like signs and symptoms in CRPS. Pain 154:961–2.
Guo TZ, Offley SC, Boyd EA, Jacobs CR and Kingery WS (2004) Substance P signalling contributes to the vascular and nociceptive abnormalities observed in a tibial fracture rat model of complex regional pain syndrome type I. Pain 108: 95-107.
Harden RN and Bruehl S (2006) Diagnosis of Complex Regional Pain Syndrome: Signs, symptoms and new epirically derived diagnostic criteria. Clinical Journal of Pain 22(5): 415-419.
Lewis JS and McCabe CS (2010) Body perception disturbance (BPD) in CRPS. Practical Pain Management 10: 60-66.
Maihofner C, Handwerker HO, Neundorfer B, and Birklein F (2003) Patterns of cortical reorganization in complex regional pain syndrome. Neurology 611707-1715.
Merskey H and Bogduk N (1994) Classification of chronic pain: Descriptions of chronic pain syndromes and definitions of pain terms. 2nd Ed. Seattle, WA: IASP Press.
Pleger B, Janssen F, Schwenkreis P, Volker B, Maier C and Tegenthoff M (2004) Repetitive transcranial magnetic stimulation of the motor cortex attenuates pain perception in complex regional pain syndrome type I. Neuroscience Letters 356: 87-90.
Pleger B, Tegenthoff M, Ragert P et al (2005) Sensorimotor retuning in complex regional pain syndrome parallels pain reduction. Annals of Neurology 57: 425-429.
Pleger B, Ragert P, Schwenkreis P, Förster AF, Wilimzig C, Dinse H, Nicholas V, Maier C and Tegenthoff M (2006) Patterns of cortical reorganization parallel impaired tactile discrimination and pain intensity in complex regional pain syndrome. Neuroimage 32: 503-510.
Punt TD, Cooper L, Hey M, Johnson MI (2013) Neglect-like symptoms in complex regional pain syndrome: learned nonuse by another name? Pain 154:200–3.
Vernadakis AJ, Koch H, Mackinnon SE (2003) Management of neuromas. Clin Plast Surg 30: 247–268, vii.