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Complex Regional Pain Syndrome (CRPS)

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What CRPS is, why it sometimes follows a wrist or hand injury or operation, how it is recognised and treated, and what recovery looks like.

Updated Sep 2026
A hand with a soft halo suggesting heightened sensitivity.
In CRPS a limb can become intensely painful, swollen and sensitive out of proportion to the original injury. Kieran Hirpara 4.0

What you're feeling

Complex regional pain syndrome (CRPS) is a condition where pain and other symptoms continue after an injury or surgery, often in ways that seem out of proportion to the original problem. It can affect your hand or arm after a fracture or an operation, and it comes from a mix of causes rather than one single thing.

The main symptom is pain. It can be severe and draining, and it may spread beyond the spot where you were injured. The pain often flares at night or after you use your hand, and it can be there when you wake. Things that stir it up include movement, touch, or pressure on the sore area. Resting the hand may settle it a little, but the pain can still linger.

Everyday tasks can become hard. You might struggle to grip a kettle, turn a key, do up buttons, or hold a pen. Writing, cooking, and carrying shopping can all feel harder than they should. Some people find they avoid using the hand because they fear the pain it brings.

CRPS is diagnosed by your history and a physical examination, not by a single scan or blood test. Your doctor will also check for other causes of ongoing pain before settling on CRPS as the explanation.

Getting it recognised and treated early matters. Prompt treatment lowers the chance of lasting loss of movement and function. Even so, some people are left with some permanent impairment or disability despite good early care.

Some people are more likely to develop CRPS than others. Women, older people, and those in heavy manual work face higher risks after wrist fracture surgery. Existing nerve problems, such as a trapped nerve or a neck nerve issue, raise the risk further. After surgery for Dupuytren contracture, women and those having more than one finger released are more likely to develop it.

If your pain feels unusual or does not settle as expected, tell your doctor early.

What's actually happening

CRPS is not damage you can see on a scan. The injury to your bone or tissue may be healing well, yet the way your body processes pain has changed. The nerves and the brain are sending and reading pain signals differently from before, so a hand that looks fine on the outside can feel burning, tender, or painful to use.

Think of it like a smoke alarm that has become too sensitive. A small wisp of smoke sets off the full alarm, and in the same way, light touch or gentle movement can set off strong pain. This is why the symptoms you read about above follow from the condition itself, not from you doing anything wrong.

Because the pain signals themselves have changed, scans and blood tests are not reliable for picking up CRPS. There is no single test that confirms it. Instead, your doctor works through your history and examination, and rules out other causes first. CRPS is only diagnosed once other explanations have been excluded, which is why you may be checked for things such as a glomus tumour, a small growth in the tiny blood vessels under the nail that can cause unusual ongoing pain.

The condition is complex, and its exact causes are still being studied. What is known is that several things can come together to trigger it. Existing nerve problems, such as a trapped nerve or a neck nerve issue, are the strongest predictors after wrist fracture surgery. Emotional distress treated before a fracture, such as anxiety or depression, roughly doubles the chance of developing CRPS during treatment. Women, older people, and those in heavy manual work also face higher risks.

Spotting it early matters because prompt treatment lowers the chance of lasting loss of movement. Even so, some people are left with some permanent impairment despite good early care.

What we can do about it

There is a lot you can do yourself, and it usually starts with movement. Keeping the hand and arm working is a central part of treatment, and physiotherapy aims to rebuild movement, strength and confidence in using the hand. It may feel strange to move something that hurts, but gentle, steady activity helps calm the oversensitive pain signals described earlier. A more active approach to recovery also lowers the chance of CRPS developing after an injury in the first place. Give this approach a fair go over weeks rather than days, and keep going even when progress feels slow. Some people also find mirror therapy helpful, where you move your unaffected hand while watching it in a mirror, and your therapist may use other treatments such as laser therapy to ease the pain.

If self-management is not enough, there are medicines that can help. Pain medication and anti-inflammatories can settle flares and make movement more comfortable, which matters because moving the hand is the main treatment. Your doctor may also suggest a short course of steroid tablets, such as prednisolone, which calm inflammation and can ease symptoms, particularly when specialist treatments are harder to access. There are also options applied directly to the skin, such as a medicated cream, which offer a simple way to manage the pain. In stubborn cases, some people are offered a ketamine infusion in hospital, which works on the pain pathways themselves. Each of these has trade-offs around side effects and how long the benefit lasts, so it is worth talking through what suits you.

If your symptoms are severe and still not settling despite the steps above, ask about seeing a specialist. A doctor may refer you for a specialist assessment, and for some specific underlying problems, a procedure may occasionally be considered. For example, where a trapped nerve in the wrist is driving the symptoms, releasing it can lead to full resolution for many people, and stiff joints that have contracted can be gently freed and then splinted. These decisions are made case by case, once other causes have been ruled out as described earlier. The sooner CRPS is recognised and treated, the better the chance of avoiding lasting loss of movement, so do not put off seeking help.

What to expect

Everyone's course with CRPS is a bit different, and there is no fixed timeline you can count on. For some people the symptoms settle over weeks to months, especially when treatment starts early. For others the pain lingers longer, and a few people are left with some permanent impairment or disability even after good early care. Early recognition and prompt treatment give you the best chance of avoiding lasting loss of movement, which is why it matters not to put off getting help.

If it is managed well, the outlook is often steady improvement rather than a sudden fix. Moving the hand, even when it hurts a little, helps calm the oversensitive pain signals described earlier, and progress usually builds slowly over weeks and months. Some treatments can make a real difference along the way. Mirror therapy and laser therapy can reduce pain, sometimes within the first few sessions. Where a trapped nerve in the wrist is driving the symptoms, releasing it can lead to full resolution of symptoms for many people. Stiff joints that have contracted can be gently freed and then splinted, which tends to go well.

If it is left alone, the picture is less certain. The pain may keep flaring, and the chance of lasting stiffness and loss of function rises the longer things drag on. In severe, long-standing cases that do not respond to any other treatment, surgery is sometimes considered as a last resort. For a small number of people with severe ongoing nerve pain, removing the lower leg below the knee has brought meaningful pain relief and acceptable function. This is not a common path, and it is only weighed up after everything else has been tried.

It is honest to say that CRPS is still not fully understood, and its causes are the subject of ongoing study. What we do know is that staying active, getting treated early, and working with your care team give you the strongest footing. Set your expectations on gradual progress, not a quick fix, and raise anything unusual with your doctor along the way.

When to see someone

See your GP or doctor early if pain after an injury or surgery keeps flaring at night, spreads beyond the injured spot, or feels far stronger than the injury itself. Ask for help if light touch, gentle movement, or temperature changes set off severe pain, or if your hand has become so painful you avoid using it. Getting CRPS recognised and treated early lowers the chance of lasting loss of movement, so do not wait for symptoms to settle on their own. Because CRPS is only diagnosed once other causes are ruled out, unusual ongoing pain should always be checked rather than put down to the original injury.

Reviewed by Kieran Hirpara · 13 June 2026.

Want the clinical detail? Read the clinician version.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

  • CRPS is a multifactorial condition that requires further study to better understand its pathogenesis, epidemiology, genetic involvement, psychological implications, and treatment options [3].
  • The diagnosis of CRPS is a clinical diagnosis based on history and physical examination [9].
  • Early recognition and prompt treatment of CRPS are important to minimize permanent loss of function [9].
  • Patients with CRPS may still experience permanent impairment and disability despite early recognition and prompt treatment [9].
  • Quantitative sensory testing outcomes indicate altered pain mechanisms in complex regional pain syndrome compared to controls, with a pooled standardized mean difference of -0.41 [5].
  • The reported incidence of CRPS is influenced by the choice of diagnostic criteria, study location, and how the fracture is managed [15].
  • A more active treatment approach seems to lower the incidence of CRPS-1 following distal radius fracture [2].
  • CRPS following isolated cubital tunnel surgery is exceedingly rare, with an overall 1-year incidence rate of approximately 0.33% [10].
  • The Hamilton Inventory can be relied upon to assess CRPS symptoms, functional limitations, and psychosocial impacts [4].

Background & Causes

Pathophysiology and Diagnosis

  • Quantitative sensory testing outcomes indicate altered pain mechanisms in CRPS compared to controls, with a pooled standardized mean difference of -0.41 [5].
  • Early recognition and prompt treatment are important to minimize permanent loss of function, though patients may still experience permanent impairment and disability [9].

Risk Factors and Incidence

  • Female sex and release of more than one digit are significant predictors of developing CRPS following treatment of Dupuytren contracture [11].
  • Elderly patients, females, and manual laborers have higher risks of developing CRPS after distal radius fracture surgery [13].
  • Preexisting neuropathic disorders, particularly traumatic nerve injuries, compressive neuropathies, and cervical radiculopathy, are the strongest predictors of CRPS after distal radius fracture [17].
  • Patients suffering from scaphoid waist fracture may be at a higher risk of CRPS I, especially in women with diabetes mellitus who report severe pain before treatment [20].
  • CRPS-related hand lesions developed in 19.4% of patients following arthroscopic rotator cuff repair [14].

Modifiable Factors and Management Implications

Symptoms & Presentation

  • CRPS is a multifactorial condition [3].
  • Pain is a highly debilitating symptom in CRPS-I [7].
  • Patients with CRPS may experience permanent impairment and disability [9].
  • Glomus tumors should be included in the differential diagnosis for patients with unusual chronic pain or neuropathy [19].
  • The diagnosis of CRPS should only be a diagnosis of exclusion [19].

Management

Pharmacologic

  • In patients presenting with chronic or refractory CRPS, strong consideration should be given for the use of ketamine [1].
  • Prednisolone is a potential treatment option for CRPS, particularly in resource-limited settings where more specialized interventions may be unavailable [6].
  • Topical application of doxepin may represent a simple option for the management of CRPS [18].

Non-Pharmacologic

  • A more active treatment approach seems to lower the incidence of CRPS-1 [2].
  • High-intensity laser therapy and mirror therapy provide conclusive evidence of pain reduction in CRPS-I, even after the third HILT treatment session [7].
  • The methodological quality of non-pharmacological treatment approaches for upper limb CRPS is overall poor [8].

Operative

  • A large percentage of patients diagnosed with and treated for CRPS type 1 can have full resolution of their symptoms with carpal tunnel release [12].
  • The positive outcome for a patient with Dupuytren's and CRPS-I after collagenase clostridium histolyticum injection is encouraging [16].

Assessment and Prognosis

  • Early recognition and prompt treatment are important to minimize permanent loss of function in CRPS [9].

Key Considerations

Diagnosis and Pathophysiology

  • The reported incidence of CRPS is influenced by choice of diagnostic criteria, along with the study location and/or how the fracture is managed [15].

Risk Factors and Incidence

Treatment

  • High-intensity laser therapy and mirror therapy offer conclusive evidence of pain reduction in CRPS-I, even after the third treatment session [7].
  • A positive outcome was observed for a patient with Dupuytren's contracture and CRPS-I after collagenase clostridium histolyticum injection [16].

Prognosis and Assessment

Key Evidence

  • [L1] In patients presenting with chronic or refractory CRPS, strong consideration should be given for the use of ketamine. [1] (10.1177/15589447221131847)
  • [L3] A more active treatment approach seems to lower the incidence of CRPS-1. [2] (10.1177/1558944719895782)
  • [L4] CRPS is a multifactorial condition that still requires further studying to better understand its pathogenesis, epidemiology, genetic involvement, psychological implications, and treatment options. [3] (10.1007/s40122-021-00279-4)
  • [L4] It can be relied upon to assess CRPS symptoms, functional limitations, and psychosocial impacts. [4] (10.1016/j.jht.2025.02.004)
  • [L1] The systematic review and meta-analysis of quantitative sensory testing outcomes indicates altered pain mechanisms in complex regional pain syndrome compared to controls, with a pooled standardized mean difference of -0.41. [5] (10.1186/s13018-022-03461-2)
  • [L4] The report emphasizes the importance of recognizing CRPS and highlights the potential of prednisolone as a treatment option, particularly in resource-limited settings where more specialized interventions may be unavailable. [6] (10.1186/s12891-024-07333-0)
  • [L1] The study results offer conclusive evidence of pain reduction, a highly debilitating symptom in CRPS-I, even after the third HILT treatment session. [7] (10.1016/j.jht.2025.02.009)
  • [L1] Methodological quality of non-pharmacological treatment approaches for upper limb CRPS is overall poor. [8] (10.1177/17589983221138610)
  • [L2] CRPS following isolated CuTS is exceedingly rare, with an overall 1-year incidence rate of approximately 0.33%. [10] (10.1016/j.jhsg.2026.101028)
  • [L3] Female sex and release of more than one digit are significant predictors of developing CRPS. [11] (10.1177/1558944720963915)
  • [L3] This study demonstrates that a large percentage of patients diagnosed with and treated for CRPS type 1 can have full resolution of their symptoms with carpal tunnel release. [12] (10.1016/j.jhsa.2024.09.024)
  • [L3] The occurrence of CRPS is the result of many factors, with elderly patients, females, and manual laborers having higher risks. [13] (10.1186/s12891-024-07948-3)
  • [L3] CRPS-related hand lesions developed in 19.4% of patients following ARCR. [14] (10.5397/cise.2021.00080)
  • [L1] The reported incidence of CRPS is influenced by choice of diagnostic criteria, along with the study location and/or how the fracture is managed. [15] (10.1177/1758998320910179)
  • [L4] The positive outcome for this woman with Dupuytren's and CRPS-I after CCH injection is encouraging. [16] (10.1016/j.jht.2024.09.002)
  • [L3] Preexisting neuropathic disorders, particularly traumatic nerve injuries, compressive neuropathies, and cervical radiculopathy, are the strongest predictors of CRPS after distal radius fracture. [17] (10.1016/j.jhsa.2026.01.004)
  • [L5] This case report suggests that the topical application of doxepin may represent a simple option for the management of CRPS. [18] (10.1016/s0020-1383(01)00054-7)
  • [Case_report] Glomus tumors should be included in the differential diagnosis for patients with unusual chronic pain or neuropathy, and the diagnosis of CRPS should only be a diagnosis of exclusion. [19] (10.1177/1558944719895618)
  • [L2] Patients suffering from scaphoid waist fracture may be at a higher risk of CRPS I, especially in women with diabetes mellitus who report severe pain before treatment. [20] (10.1186/s12891-021-04977-0)

References

[1] Pharmacologic Treatments in Upper Extremity Complex Regional Pain Syndrome: A Review and Analysis of Quality of Evidence. HAND. 2022. DOI: 10.1177/15589447221131847

[2] Treatment of Distal Radius Fracture: Does Early Activity Postinjury Lead to a Lower Incidence of Complex Regional Pain Syndrome?. HAND. 2020. DOI: 10.1177/1558944719895782

[3] Complex Regional Pain Syndrome: A Comprehensive Review. Pain and Therapy. 2021. DOI: 10.1007/s40122-021-00279-4

[4] Psychometric evaluation of the Hamilton Inventory to evaluate signs and symptoms in patients with Complex Regional Pain Syndrome (CRPS). Journal of Hand Therapy. 2025. DOI: 10.1016/j.jht.2025.02.004

[5] Pain mechanisms in complex regional pain syndrome: a systematic review and meta-analysis of quantitative sensory testing outcomes. Journal of Orthopaedic Surgery and Research. 2023. DOI: 10.1186/s13018-022-03461-2

[6] Complex regional pain syndrome: diagnostic challenges and favorable response to prednisolone. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-024-07333-0

[7] Effect of high-intensity laser therapy and mirror therapy on complex regional pain syndrome type I in the hand area: A randomized controlled trial. Journal of Hand Therapy. 2025. DOI: 10.1016/j.jht.2025.02.009

[8] Person-centred management of upper limb complex regional pain syndrome: an integrative review of non-pharmacological treatment. Hand Therapy. 2023. DOI: 10.1177/17589983221138610

[9] Complex Regional Pain Syndrome. 2021.

[10] Incidence and Patient-Level Risk Factors for Complex Regional Pain Syndrome Following Cubital Tunnel Surgery. Journal of Hand Surgery Global Online. 2026. DOI: 10.1016/j.jhsg.2026.101028

[11] Separating Fact From Fiction: A Nationwide Longitudinal Examination of Complex Regional Pain Syndrome Following Treatment of Dupuytren Contracture. HAND. 2020. DOI: 10.1177/1558944720963915

[12] Outcomes of Median Nerve Release in Complex Regional Pain Syndrome Type 1 of the Hand: A Prospective Case Series. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2024.09.024

[13] Dynamic risk factors for complex regional pain syndrome after distal radius fracture surgery: multivariate analysis and prediction. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-024-07948-3

[14] Clinical outcome in patients with hand lesions associated with complex regional pain syndrome after arthroscopic rotator cuff repair. Clinics in Shoulder and Elbow. 2021. DOI: 10.5397/cise.2021.00080

[15] What is the incidence of complex regional pain syndrome (CRPS) Type I within four months of a wrist fracture in the adult population? A systematic review. Hand Therapy. 2020. DOI: 10.1177/1758998320910179

[16] The case of a woman with bilateral Dupuytren’s contractures who developed CRPS-1 after fasciectomy with no relapse on subsequent collagenase clostridium histolyticum injection and manipulation of the other hand: Considerations for implementing a Budapest criteria checklist and assessing vasomotor instability by measuring differences in skin temperature. Journal of Hand Therapy. 2025. DOI: 10.1016/j.jht.2024.09.002

[17] A Nationwide Propensity Score-Matched Analysis Identifying Preinjury Predictors of Complex Regional Pain Syndrome Following Distal Radius Fracture. The Journal of Hand Surgery. 2026. DOI: 10.1016/j.jhsa.2026.01.004

[18] Topical application of doxepin hydrochloride can reduce the symptoms of complex regional pain syndrome: a case report. Injury. 2002. DOI: 10.1016/s0020-1383(01)00054-7

[19] An Unusual Case of Periosteal Glomus Tumor at the Metacarpal Base Presenting as Type II CRPS: Case Report. HAND. 2020. DOI: 10.1177/1558944719895618

[20] Determinants of complex regional pain syndrome type I in patients with scaphoid waist fracture- a multicenter prospective observational study. BMC Musculoskeletal Disorders. 2022. DOI: 10.1186/s12891-021-04977-0

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For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

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