Complex Regional Pain Syndrome

Establish CRPS only when there is continuing pain disproportionate to any inciting event; the patient reports at least one symptom in three of four domains; the examiner identifies at least one sign in two or more domains; and no competing diagnosis better accounts for the findings. The four domains are sensory, vasomotor, sudomotor/edema, and motor/trophic. cdn clinicaltrials+1cdn clinicaltrialsConfidential Protocol KF7013-02 including Amendment 01 ...PubMedComplex Regional Pain Syndrome - StatPearls - NCBI Bookshelf

Elicit symptoms separately from observed signs. Sensory symptoms are hyperesthesia or allodynia; vasomotor symptoms are temperature asymmetry or skin-color change/asymmetry; sudomotor/edema symptoms are edema, sweating change, or sweating asymmetry; motor/trophic symptoms are reduced range of motion, motor dysfunction, or trophic skin, hair, or nail change. At examination, document corresponding objective asymmetry in the affected and contralateral limbs. cdn clinicaltrials+1cdn clinicaltrialsConfidential Protocol KF7013-02 including Amendment 01 ...ScienceDirectComplex Regional Pain Syndrome Type II - an overview

Use the clinical rather than research Budapest criteria for routine care. Reported validation estimates for the clinical criteria are sensitivity 0.99 and specificity 0.68; therefore, a positive assessment should trigger a deliberate search for mimics rather than automatic diagnostic closure. ScienceDirect+1ScienceDirectComplex Regional Pain Syndrome - an overviewScienceDirectComplex Regional Pain Syndrome Type II - an overview

Start with a focused history and examination for fracture complications, postoperative infection, focal peripheral nerve injury, vascular pathology, inflammatory joint disease, and severe or progressive neurologic deficits. Imaging or other diagnostic testing should be obtained when examination or history suggests a serious underlying condition or progressive neurologic deficit, not to confirm CRPS in isolation. CDCCDCCDC Clinical Practice Guideline for Prescribing Opioids ...

Differentiate focal peripheral nerve injury from CRPS before labeling type II disease. Peripheral nerve injury is supported by a lesion history, somatosensory abnormalities within the injured nerve territory, and—when the nerve is accessible—electrophysiologic evidence of nerve damage. In contrast, CRPS commonly has generalized distal, regional findings that extend beyond a single named nerve territory. ScienceDirectScienceDirectSensory signs in complex regional pain syndrome and peripheral nerve injury

The clinical phenotype may evolve. Early "warm" CRPS is described as inflammation-predominant, whereas chronic "cold" CRPS is more autonomic-feature predominant; this pattern can help frame serial examinations but does not replace Budapest criteria or exclusion of mimics. BMJBMJComplex regional pain syndrome | The BMJ

Refer for physical therapy and, when upper-extremity activities or self-care are impaired, occupational therapy with explicit goals for active range of motion, limb use, and progressive function. Manual therapy and exercise are associated with improved range of motion and function and reduced disability; therapy should be integrated with pain management rather than deferred until pain resolves. PubMedPubMedComplex Regional Pain Syndrome - StatPearls - NCBI Bookshelf

Include graded motor imagery or mirror therapy when pain, allodynia, movement avoidance, or body-perception disturbance limits limb engagement. These approaches are among nonpharmacologic interventions used within CRPS rehabilitation, and randomized-trial reviews cited in a state-of-the-art review support physical/occupational therapy including graded motor imagery and mirror therapy. BMJ+1BMJComplex regional pain syndrome | The BMJPubMedComplex Regional Pain Syndrome - StatPearls - NCBI Bookshelf

Assess function, work demands, sleep, psychosocial stressors, and behavioral factors at each treatment decision because these factors affect pain-treatment selection and rehabilitation participation. Psychological support should be incorporated when distress, fear, or other behavioral barriers interfere with recovery; it is not evidence that symptoms are psychogenic. PubMed+1PubMedComplex Regional Pain Syndrome - StatPearls - NCBI BookshelfCDCCDC Clinical Practice Guideline for Prescribing Opioids ...

Drug selection should be individualized to the dominant barrier—such as inflammatory features, neuropathic pain, sleep disruption, or inability to participate in therapy—and reviewed against functional benefit rather than pain score alone. Agents used in CRPS care include nonsteroidal anti-inflammatory drugs, anticonvulsants, and corticosteroids, but the evidence base is limited and there are no FDA-approved pharmacologic treatments for CRPS. PubMed+1PubMedComplex Regional Pain Syndrome - StatPearls - NCBI Bookshelfcdn clinicaltrialsConfidential Protocol KF7013-04 including Amendment 01 Page ...

In early inflammation-predominant disease, oral corticosteroids have supportive randomized-trial review evidence, but the provided literature does not establish a regimen. Prescribe only after weighing infection, glycemic, psychiatric, bone, and other patient-specific corticosteroid risks, and define a short-interval reassessment of function and adverse effects. BMJ+1BMJComplex regional pain syndrome | The BMJclinicaltrialsStudy Details | NCT06453447 | Prednisone for CRPS in Distal Radius Fracture | ClinicalTrials.gov

Bisphosphonates, calcitonin, subanesthetic intravenous ketamine, and free-radical scavengers have been reported as potentially effective in randomized-trial reviews, but treatment selection should be made by clinicians experienced with CRPS and the agent-specific safety profile. Do not infer an FDA indication, standardized dose, or universal sequencing from these data. BMJ+1BMJComplex regional pain syndrome | The BMJcdn clinicaltrialsConfidential Protocol KF7013-04 including Amendment 01 Page ...

For persistent disabling CRPS after conservative multidisciplinary care, discuss spinal cord stimulation as an adjunct to—not a replacement for—physical therapy. An ASA/ASRA guideline cites one randomized controlled trial in which spinal cord stimulation plus physical therapy provided effective pain relief compared with physical therapy alone from 6 months through 2 years. asahqasahqPractice Guidelines for Chronic Pain Management

Dorsal root ganglion stimulation is another neuromodulation approach for CRPS and causalgia. Comparative evidence summarized in a 2024 report found higher treatment success with dorsal root ganglion stimulation at 3 and 12 months; selection should account for pain distribution, procedural candidacy, patient goals, and local expertise. JAMAJAMASpinal Cord Stimulation vs Medical Management for ...

Continue to measure disability and function after implantation rather than defining success only by analgesia. Neuromodulation is reasonable only when the expected improvement justifies device-related procedural burden and the patient can continue active rehabilitation. CDC+1CDCCDC Clinical Practice Guideline for Prescribing Opioids ...asahqPractice Guidelines for Chronic Pain Management

At follow-up, repeat the bilateral assessment of pain distribution, allodynia or hyperalgesia, temperature and color asymmetry, edema or sweating asymmetry, range of motion, motor performance, and trophic change. A transition from warm inflammatory features to cold autonomic features has been described as CRPS becomes chronic, but new focal deficits should prompt renewed evaluation for peripheral nerve or structural disease. BMJ+1BMJComplex regional pain syndrome | The BMJScienceDirectSensory signs in complex regional pain syndrome and peripheral nerve injury

Counsel that outcomes are heterogeneous: many cases resolve within the first year, while a smaller subgroup progresses to chronic CRPS with persistent pain and disability. Early diagnosis and treatment are associated with improved outcomes, supporting prompt rehabilitation rather than prolonged observation while awaiting a confirmatory test. BMJ+1BMJComplex regional pain syndrome | The BMJPubMedComplex Regional Pain Syndrome - StatPearls - NCBI Bookshelf

Document treatment response using functional endpoints: limb use, active range of motion, activity tolerance, work demands, sleep, and ability to participate in prescribed therapy. If these measures do not improve, revisit the diagnosis, treatment adherence, psychosocial barriers, and whether an interventional strategy could meaningfully enable rehabilitation. CDCCDCCDC Clinical Practice Guideline for Prescribing Opioids ...