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Understanding the name and general mechanism
Complex regional pain syndrome, abbreviated CRPS, is sometimes called algodystrophy or Sudeck's disease. It can appear after an injury or an operation, sometimes without a clearly identified trigger. The pain appears greater or longer lasting than is usually expected for the initial event.
The mechanisms are complex and not fully understood. The nervous system, inflammation and tissue regulation can intervene. This doesn't mean the pain is imaginary or that you lack willpower. The hand, wrist or arm may be affected; the assessment takes into account all the signs and their evolution.
Chapter sources [1]
Understand the picture
Several dimensions to examine together
Sensitivity
Persistent pain and unusual reaction to touch.
Appearance and regulation
Swelling, color, temperature or sweating may change.
Movement and function
Stiffness and difficulty of use follow the other signs.
Chapter sources [1]
Possible symptoms
The pain may be burning, deep, or very sensitive to contact. Light clothing, water or touch that is usually not painful can become difficult to bear. The hand may swell, sweat differently, or change color and temperature. Symptoms can vary during the same day.
Stiffness, weakness or difficulty initiating certain movements may also appear. Skin, nails or hair may change. Not all people have all the signs, and their presence is not enough to make the diagnosis yourself. Describe concrete changes and lost activities, without trying to provoke pain to prove its intensity.
Chapter sources [1]
After an injury: when to discuss a reassessment
Fracture recovery can include pain, swelling and stiffness without being CRPS. On the other hand, very significant pain that persists, extreme sensitivity or unusual changes justify seeing the team again. The goal is not to trivialize developments that deviate from the expected path.
An infection, a circulation problem, nerve compression or difficulty in bone healing can also explain symptoms. These causes must be considered. A suddenly cold, pale, or numb hand, rapidly increasing pain, or fever should not be attributed simply to algodystrophy. Request an urgent evaluation based on the signs present.
How the diagnosis is made
The diagnosis is based on the history and a set of signs observed during the examination. The doctor looks for pain and changes in sensation, circulation, swelling and movement. They check that another explanation does not better account for the situation.
There is no single blood test or image that alone confirms CRPS. Tests can help rule out other causes or clarify some associated problems. A normal image therefore does not mean that your pain does not exist. Ask what supports the diagnosis, what remains uncertain, and what changes require contacting the team again.
Chapter sources [2]
Organize coordinated support
Care can combine information, pain treatment, physical rehabilitation and psychological support as needed. A pain specialist or a rehabilitation team can intervene. The goal is to reduce symptoms, preserve function and make daily life easier.
Psychological support does not mean that the pain is invented. It can help cope with the fear of movement, sleep disturbances or exhaustion that accompany persistent pain. Professionals must coordinate their messages. Ask who to contact in the event of a flare-up and what realistic goals will be followed, rather than a succession of treatments with no reference point.
Chapter sources [4]
Physiotherapy: resume without forceful movements
The physiotherapist can help gradually regain tolerable movements and activities. A graduated recovery aims to avoid both prolonged abandonment of all use and sessions that cause significant flare-ups. The dose depends on sensitivity, the initial injury and the reaction after exercise.
A small, slow, steady movement can be a good start. The goal is not to endure maximum pain to overcome the problem. The instructions for protecting a fracture or repair remain valid. If a program causes lasting worsening of pain or causes loss of capacity, it should be re-evaluated rather than automatically intensified.
Chapter sources [4]
In everyday life
Choose an accessible activity
Define
Choose a small task that is important and currently tolerable.
Dose
Start with an amount that does not cause lasting aggravation.
Adjust
Track the reaction and build up gradually with a plan for the tough days.
Chapter sources [4]
Desensitization, mirror therapy and other approaches
A very gradual exposure to textures or contacts can sometimes be suggested to reaccustom the hand to certain sensations. Other approaches, such as motor imagery or mirror work, are used in certain situations. Their choice and tolerance must be discussed with a professional.
These techniques do not constitute a guaranteed recipe nor an obligation to continue despite significant worsening. A mirror or a texture may be poorly tolerated by some people. Start according to the instructions received and describe the reaction. The general exercises on the site are not a substitute for this individualized program and should not be used to push a very sensitive hand beyond its capabilities.
Chapter sources [4]
Specialized medications and treatments
The doctor can discuss medications based on the type of pain, your health and possible side effects. Some treatments require a gradual increase or supervised cessation. An option that is useful for one person may not be suitable for another. This guide does not suggest a dose or combination to try alone.
If the difficulties remain significant, a specialized team can consider other approaches. Ask about the expected benefit, quality of evidence, risks and alternatives. A more technical intervention does not guarantee a cure. Treatment must remain linked to functional objectives and reassessment, in addition to appropriate support for movement and daily life.
Chapter sources [4]
Sleeping, Bathing, Working, and Managing a Flare-Up
Break up difficult tasks and choose an accessible goal, such as using your hand for a few moments for a light activity. If possible, keep a general routine, with rest periods and appropriate activity for the rest of the body. Comfortable clothing or support can reduce painful contact.
Prepare with the team a strategy for more difficult days: temporarily reduce the quantity, keep what remains tolerable and resume gradually. A flare-up does not necessarily mean a new injury, but a new symptom must be evaluated. At work, a return to work may require adaptations of duration and tasks. There is no universal timetable.
Chapter sources [4]
Evolution, progress and limits
Some people improve markedly; others experience prolonged difficulties. Progress can be slow and irregular. Better tolerance to contact, less disturbed sleep or a regained task are useful progress, even if the pain has not disappeared.
Follow these benchmarks with the team and adjust goals. A lack of progress, adverse effects or a program that is too difficult merits re-evaluation. Wound redness, fever, rapid deterioration of circulation or new weakness should not be ignored on the grounds that CRPS has already been mentioned. Recognizing uncertainty allows for more appropriate care than a promise of cure.
Your questions
Is the pain in my head?
The pain is real. The nervous system participates in its production and modulation, as in all pain, but that does not make it imaginary. Psychological support can help with sleep, fear, and coping without replacing medical evaluation or physical rehabilitation.
Chapter sources [4]
Should the hand be immobilized until the pain disappears?
Not as a general rule of CRPS. Appropriate resumption of use is part of the care, while respecting a possible fracture or repair. Prolonged immobilization and excessive strain can each be problematic. The program must be individualized.
Chapter sources [4]
Does a normal x-ray rule out CRPS?
No. The diagnosis is clinical and based on several elements. The examinations are used in particular to look for other causes. A normal image is neither sufficient to confirm nor exclude the syndrome; it must be interpreted with history and examination.
Chapter sources [2]
Should I continue an exercise that triggers a strong surge?
Don't force it automatically. Reduce or interrupt the action and discuss its dose with the clinician. A graduated recovery is not intended to cause maximum pain. A new symptom or rapid deterioration requires evaluation.
Chapter sources [4]
Sources and references
- [1] NHS · Complex regional pain syndrome
- [2] NHS · Complex regional pain syndrome: diagnosis
- [3] NHS: Broken arm or wrist
- [4] NHS · Complex regional pain syndrome: treatment
- [5] NHS: Wrist pain
- [6] CGDIS · Appeler le 112
Text updated on
Medical review: awaiting Hasib Selimovic.