There's no known cure for complex regional pain syndrome (CRPS), but a combination of physical treatments, medication and psychological support can help manage the symptoms.
It's estimated that around 85% of people with CRPS slowly experience a substantial reduction in their pain and some of their symptoms over the first two years after the condition starts.
However, some people experience continuous pain despite treatment. In rare cases, further problems may develop, such as muscle wastage in the affected limb.
There's currently no way to predict who will improve and when this may happen.
Your treatment plan
Treatment for CRPS involves four main areas:
- education and self-management – advice about any steps you can take to help manage the condition
- physical rehabilitation – to help improve your function and reduce the risk of long-term physical problems
- pain relief – treatments to help reduce your pain
- psychological support – interventions to help you cope with the emotional impact of living with CRPS
Some of the main treatments used are described below.
As part of your treatment, you will be advised about things you can do yourself to help control your condition.
This may include:
- education – to help you understand your condition
- support to stay active and use the affected body part
- learning techniques to help you manage increases in pain
- learning relaxation methods to help improve your quality of life
- advice regarding activity management – to help avoid peaks and dips in activity despite pain
- continuing rehabilitation treatments at home, such as desensitisation techniques (see below)
- accessing any support groups in your local area
Read more advice about living with pain.
Physical rehabilitation involves a number of different treatments.
The aim of these treatments is to gradually allow people to increase their activities and function without making the pain worse. This can be difficult as any movements or stimulation of the limb will increase pain or the other symptoms of CRPS such as swelling, colour changes and sweating.
If exercise or therapy is pushed too hard this can aggravate the condition so it's important for your therapy to be delivered or supported by a therapist with experience of CRPS.
Some of the techniques that may be used as part of your physical rehabilitation programme are described below.
Your exercise plan may include a range of gentle exercises, from simple stretches to exercises in water (hydrotherapy) or weight-bearing exercises.
Desensitisation is a technique used to reduce the sensitivity of body parts affected by CRPS.
It usually involves touching an unaffected body part, close to the affected body part, with materials of different textures, such as wool and silk, and concentrating on how this feels. The same materials are then gradually applied to the painful, affected body part while trying to recall what it felt like when you were touching the unaffected body part.
This process is likely to be uncomfortable or painful at first, but it may eventually reduce the sensitivity in the affected body part so it's more similar to unaffected areas.
Mirror visual feedback and graded motor imagery
Performing movement can often be difficult, as information which the brain needs to perform movements is often missing or confused.
Several techniques, such as mirror visual feedback and graded motor imagery, aim to improve movements by retraining the brain in respect to these missing or confused bits of information.
There are several medicines that may help to treat CRPS, which your pain specialist will be able to discuss with you.
Your treatment team will try lower-strength painkillers first, and will only use stronger painkillers if necessary.
None of the medicines used to treat people with CRPS are licensed for this use in the UK. This means these medicines may not have undergone clinical trials to see if they're effective and safe in treating CRPS specifically.
However, these medications will have a licence to treat another condition and will have undergone clinical trials for this. Doctors may choose to use an unlicensed medication if they're thought to be effective and the benefits of treatment outweigh any risks.
Some of the main pain relief treatments are discussed below.
Non-steroidal anti-inflammatory drugs (NSAIDs)
The first painkillers often used to treat CRPS are over-the-counter painkillers called non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen.
These medications can help reduce the pain caused by the injury that triggered CRPS. They can also treat CRPS-associated pains, such as muscle pain in the shoulder when the CRPS is in the hand. However, NSAIDs are unlikely to directly reduce CRPS pain.
Anticonvulsants are usually used to treat epilepsy, but have also been found to be useful for treating nerve pain. Gabapentin and pregabalin are the most widely used anticonvulsants for treating CRPS.
Common side effects of these medications include drowsiness, dizziness and weight gain. There's a small increased risk of suicidal thoughts, which may be seen as early as a week after starting treatment.
You should avoid suddenly stopping treatment with these medications, because you may experience withdrawal symptoms. If you feel you no longer need to take it, your GP will arrange for your dose to be slowly reduced over a period of at least a week.
Tricyclic antidepressants (TCAs) were originally designed to treat depression, but like anticonvulsants were found to be effective in treating nerve pain. Amitriptyline and nortriptyline are the most widely used TCAs for treating CRPS, although nortriptyline generally has fewer side effects.
These medications can often improve sleep, and are generally taken in the early evening, to reduce the risk of "hangover" effects the next morning.
Possible side effects include:
- dry mouth
- blurred vision
- heart palpitations
- difficulty urinating
You may experience withdrawal effects if you stop taking these medications suddenly. If you feel you no longer need to take TCAs, your GP will arrange for your dose to be slowly reduced over a period of at least four weeks.
If you're experiencing severe pain, opioids such as codeine and morphine can sometimes provide pain relief.
Common side effects of opiate painkillers include:
- nausea and vomiting
- dry mouth
- cognitive problems (thinking processes can be slower)
Long-term use of high doses has been linked to more serious problems, such as depression, absent periods in women, and erectile dysfunction in men.
The benefits of using opioids may sometimes outweigh the risks, but unfortunately these medications are often not very effective in CRPS. Long-term use of high doses is generally not recommended, although exceptions may be made in a small number of cases under the care of a pain specialist.
Although addiction is rare, there's a risk you may become dependent on opioids. This means your body and mind don't want to stop taking them, even if they're not very effective. You may feel worse for a limited period of time when you do reduce or stop taking them.
Spinal cord stimulation
If medication doesn't lessen your pain, a treatment called spinal cord stimulation may be recommended.
This involves having a device placed under the skin of your tummy or buttocks, attached to a lead placed close to your nerves in the spine. This device produces mild electrical pulses that are sent to your spinal cord.
These pulses change how you feel pain. You may feel a tingling sensation in the part of your body that usually hurts, which masks the pain. The level of stimulation can be adjusted as your pain improves or gets worse, and the device can be removed if necessary.
The National Institute for Health and Care Excellence (NICE) states that spinal cord stimulation should only be considered if:
- you're still experiencing pain after six months of trying other treatments
- you've had a successful trial of the stimulation – the trial only involves placing the leads, not implanting them
Your care team will discuss spinal cord stimulation with you if they think it could help.
Living with a long-term, painful condition can be distressing, and people with CRPS may experience psychological problems, such as anxiety and depression.
It's important to look after your psychological wellbeing, because feelings of depression and anxiety can interfere with your rehabilitation.
Psychological therapies can also be useful in helping you cope better with the symptoms of pain. For example, some studies have shown that cognitive behavioural therapy (CBT) can help in the management of long-term pain.
These therapies are often taught to small groups of patients with severe pain, together with rehabilitation techniques, in programmes called "pain management programmes" (see below).
The aim of CBT is to help you understand how your problems, thoughts, feelings and behaviour can affect each other. By discussing and altering how you feel about your condition, CBT can help you cope with your symptoms and make it easier for you to continue with your rehabilitation programme.