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Complex Regional Pain Syndrome Treatments and Medications

Medically reviewed by Josephine Bawab, Pharm.D.
Licensed Pharmacist
Updated Mar. 22, 2021  •  Published Mar. 22, 2021
Fact Checked

Living with chronic pain can make everyday tasks difficult to navigate. For someone with complex regional pain syndrome (CRPS), a painful condition that affects the nervous system, this is a daily reality. While there isn't a cure for CRPS, it can be well-managed with the right balance of medications, holistic treatments, and lifestyle modifications. Let's look at what makes this condition so complicated and what people can do to improve their quality of life while living with it?

What is complex regional pain syndrome (CRPS)?

CRPS, formally known as reflex sympathetic dystrophy syndrome (RSD), is a chronic pain condition that usually develops after an injury, stroke, or surgery. It is not fully clear why some people develop the condition and others don't. According to the National Institute of Neurological Disorders and Stroke, CRPS is triggered by nerve trauma or injury to the affected limb that damages the thinnest sensory and autonomic nerve fibers in more than 90% of cases. It is rare, with fewer than 200,000 cases diagnosed in the United States every year.

The exact cause of CRPS is not well understood. It usually affects the arms, legs, hands and feet, although it could appear anywhere in the body. It is thought to occur when there is dysfunction of nerve signaling from the brain and spinal cord to the rest of the body, sending pain signals to the affected body part. This could also result in allodynia, pain from a stimuli which would not otherwise be painful. The peripheral nervous system also can send signals of inflammation and other imbalances.

There is no cure for CRPS. For most people, symptoms usually diminish over time and can be managed with medications and lifestyle modifications. In some cases, the condition doesn't go away and can be quite debilitating. Typically, people have one level of baseline pain or discomfort, with flare-ups that can be triggered by a number of factors. A flare-up could last from a few hours to a few days.

Symptoms of CRPS vary greatly and can include:

  • Continuous, often severe pain in the affected limb that can sometimes radiate to other areas
  • Sensitivity to heat or cold
  • Burning (causalgia), throbbing, or stinging pain
  • Swelling and inflammation in the surrounding area
  • Changes in skin temperature
  • Changes in skin texture, which may become tender in the affected area
  • Changes in nail and hair growth
  • Tremors and muscle spasms
  • Reduced mobility in the affected area
  • Joint stiffness
  • Atrophy due to inactive muscles
  • Depression, anxiety, or stress

How is CRPS diagnosed?

While there isn't one specific diagnostic test for CRPS, if someone is experiencing symptoms following an injury, they should consult a healthcare professional who will be able to make a determination. They may run some tests to rule out other conditions first since symptoms of CRPS can be similar to other more treatable diagnoses.

A healthcare provider may do a bone scan to identify changes in the bone and blood circulation or X-rays to see if the original injury is healed. An MRI may show tissue changes to rule out other conditions, which may lead to running nerve conduction tests.

While anyone can develop it, CRPS is more common in women than men and peaks around 40 years of age. Children and older adults are less likely to develop it. Some people with a history of physical or emotional trauma may be more susceptible.

CRPS treatment options

Since symptoms vary from person to person and may change over time, CPRS can be very difficult to diagnose and treat. In general, the sooner someone gets a diagnosis and starts treatments after the initial injury, the more likely he or she is to respond to treatment. While many cases get better on their own over time, some people live with chronic pain that may require a combination of medication, therapy, and procedures.

Javeed Siddiqui, MD, the chief medical officer at TeleMed2U, says that chronic pain therapy can be challenging for both the medical professional and the patient. "Chronic pain management is complicated by the development of tolerance and possibly dependence along with a number of side effects from chronic pain medication utilization,” says Dr. Siddiqui. “Holistic treatments can play an important role in the management of CRPS. Medical professionals need to be careful not to be dismissive of holistic or naturopathic treatments in this and other disease states.”

Alternative medicine and education

  • Acupuncture to stimulate blood flow and reduce pain and inflammation. Acupuncture can also help stimulate nerve regeneration.
  • Pain management education with a pain specialist to learn how to manage flare-ups and what triggers them.

CRPS therapies

  • Physical therapy to increase strength and circulation in the affected limb.
  • Occupational therapy to learn how to safely move and function in daily life and keep a safe home environment.
  • Biofeedback,a form of therapy that uses sensors attached to the body, to measure key body functions, to help learn how the body responds to stimuli and help manage pain signals.
  • Graded motor imagery and mirror therapy,to train the brain to identify and recognize the affected limb.
  • Psychotherapy,to address the emotional challenges of being diagnosed with a chronic illness and living with pain.
  • Art or music therapy to creatively identify, address, and process the pain, and serve as a distraction.

CRPS procedures

  • Sympathectomy,an invasive procedure that cuts or blocks sympathetic nerves, to increase blood flow and stop the fight or flight response.
  • Lidocaine infusions, which can provide comfort for neuropathic pain.
  • A study from the Cleveland Clinic shows that deep brain stimulation (DBS) can potentially help with chronic pain.
  • Spinal cord stimulation, which sends electrodes down the spinal cord to block pain signals before they reach the brain.

CRPS medications

There are a variety of medications used to treat CRPS, depending on the severity and the specific symptoms. These may include nerve pain medication, muscle relaxants, narcotics, anesthetics, and more.

Analgesics

Nonsteroidal anti-inflammatory drugs, or NSAIDs, including over-the-counter (OTC) pain relievers such as ibuprofen (Motrin IB, Advil) and aspirin,may provide pain relief. For more severe cases, a doctor may prescribe opioid medications to help control the pain,but high doses should be avoided.

Anticonvulsants

Anticonvulsants, such as gabapentin (Neurontin), are often used to treat neuropathic pain. These medications have nerve-calming properties that can alleviate symptoms of CRPS.

Antidepressants

Some antidepressants, such as amitriptyline, have been shown to decrease pain and reduce autonomic and motor symptoms. Antidepressants can also help with depression, stress, and anxiety, which can trigger CRPS flare-ups.

Bisphosphonates

A class of drug that prevents or stalls the loss of bone density, including alendronate (Fosamax), have been shown to decrease pain

Corticosteroids

Steroid medications, such as prednisone, can help reduce inflammation and improve mobility in the affected limb.

Intravenous ketamine

Some clinical trials show that low doses of intravenous ketamine, a strong anesthetic, may substantially alleviate pain.

Sympathetic nerve-blocking medication

Injection of an anesthetic to block pain fibers in the affected nerves may relieve pain in some people.

What is the best medication for CRPS?

The right medication to treat CRPS will vary depending on the patient's medical history, the severity of the condition, and other medications he or she may be taking, as well as the patient's individual response to CRPS treatments. The following medications could be helpful:

Best medications for CRPS
Drug Name Drug Class Administration Route Standard Dosage Common Side Effects
Neurontin (gabapentin) Anticonvulsant Oral 300 mg orally three times a day Drowsiness, dizziness, headache
Elavil (amitriptyline) Tricyclic antidepressants Oral 25 mg orally four times a day Nausea, vomiting, drowsiness
Deltasone (prednisone) Corticosteroid Oral 5-60 mg orally once a day Headache, dizziness, insomnia
MS Contin (morphine) Opioid Oral 30 mg orally as needed Hypotension, constipation, drowsiness
Ketalar (ketamine) Anesthetic Injection 1-4.5 mg/kg IV Confusion, blurred vision, dizziness
Fosamax (alendronate) Bisphosphonate Oral 70 mg orally once a day, on an empty stomach Acid reflux, indigestion, constipation
Motrin (ibuprofen) NSAID Oral 200 mg orally as needed Nausea, dizziness, headache

Dosage is determined by a medical professional based on the medical condition, response to treatment, age, and weight. Other possible side effects exist. This is not a complete list.

What are the common side effects of CRPS medication?

Side effects will vary from person to person, and patients should consult a healthcare professional to learn about side effects before taking any medication. This is not a comprehensive list of all possible side effects, but some common ones across CRPS medications include:

  • Dry mouth
  • Weight gain
  • Dizziness
  • Difficulty concentrating
  • Headaches

What is the best home remedy for CRPS?

CPRS responds well to a mix of medication, holistic treatments, and lifestyle modifications. Since CRPS is often aggravated by stress, anything a patient can do to calm their nervous system will help. The goal is to get out of the "fight or flight" mode triggered by the sympathetic nervous system and into the "rest and digest" mode that comes from the parasympathetic nervous system. Patients should pay attention to what triggers their flare-ups and maybe even consider keeping a journal. Creating a safe environment for themselves and maintaining a self-care routine is important. This can include:

  • Relaxation techniques: Diaphragmatic breathing and meditation can ease the mind and provide distraction from the pain.
  • Daily exercise Exercise improves circulation and helps rehabilitate damaged nerves, as well as stimulate "feel-good" endorphins. Beneficial activities include walking, swimming, biking, yoga, and Tai Chi as tolerated.
  • Anti-inflammatory dietLeafy greens, berries, nuts, and fatty fish can reduce inflammation and supply important nutrients.
  • Epsom salt baths Relaxing baths can soothe the body and mind while reducing pain.
  • Vitamins and supplements Fish oil is a natural anti-inflammatory.
  • Heat therapy Heated blankets or infrared saunas can be used if tolerated.
  • A regular sleep routine Sleep helps the body and brain reset and restore. Helpful tips to improve sleep quality include turning off screens before bedtime, taking a soothing bath, taking melatonin if needed, and aiming for at least eight hours of restful sleep.
  • Keep the home safe For those using canes or with mobility issues, clutter and tripping hazards should be eliminated.
  • Avoid potential triggers Knowing when to say "no" to something if it's going to cause or aggravate a flare-up and putting up healthy boundaries can help prevent stressful triggers.
  • Reach out to support from loved ones They might not understand what it's like living with a chronic condition, and the more information shared, the better they can help.

Frequently asked questions about CRPS

What causes complex regional pain syndrome?

CRPS is caused by the dysfunction in the nervous system, causing it to send inappropriate pain signals and inflammatory responses to the brain after an injury, break, or surgery. This can result in severe chronic pain, immobility, inflammation, swelling, and a number of other symptoms.

What aggravates CRPS?

Flare-ups are different for everyone, but some common triggers are stress, cold or heat, inflammation, emotional or physical trauma, weather changes, and too much or not enough activity. Knowing individual triggers and how to manage flare-ups are key to maintaining high quality of life.

What are the stages of CRPS?

There are three stages of CRPS.
  • Stage 1—Acute/dysfunction phase: Burning pain, swelling, increased sensitivity, joint stiffness, skin becoming warmer
  • Stage 2—Dystrophy: Muscle weakness, hypersensitivity, bone mass reduction
  • Stage 3—Atrophy: Functional impairment, osteoporosis, skin becoming cooler

What is the best treatment for CRPS?

Patients with CRPS benefit from a combination of medications, holistic modalities, and home remedies. Pain management education, physical therapy, acupuncture, relaxation techniques, exercise, and psychotherapy are all valuable complements to treatment.

Is CRPS permanent?

The course of CRPS varies from person to person. For most individuals, the nerves eventually repair themselves and the condition improves over time. In some cases, the damage is so severe that the condition does not go away. Many people live with baseline pain and discomfort for several years with occasional flare-ups.

How long does it take to recover from CRPS?

Recovery time will vary based on the severity of symptoms, aggressiveness of treatments, and a person's individual response. Some people find recovery in several months; for others, it takes several years or longer.

Related resources for complex regional pain syndrome

Medically reviewed by Josephine Bawab, Pharm.D.
Licensed Pharmacist

Josephine Bawab, Pharm.D., graduated from Virginia Commonwealth University School of Pharmacy. She began working in community pharmacy in 2012 and has worked for multiple chain pharmacies since then. She is passionate about helping patients and precepting students. She currently works and resides in Virginia, where she is just a few minutes away from the beach.

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