Foot & Ankle Surgery located in Fort Worth and Weatherford, TX

Complex Regional Pain Syndrome (CRPS)

Complex regional pain syndrome is a multifactorial disorder. CRPS is formally known as Reflex Sympathetic Dystrophy (RSD) and/or Causalgia. It is a systemic disease characterized by severe pain, swelling, and changes in the skin. Response can be secondary to injury and at times post surgery.


The cause of CRPS is unknown though CRPS has been associated with dysregulation of the central nervous system. Smoking has been linked to an increase in incidence. An original injury initiates a pain impulse which is carried from the sensory nerves to the central nervous system. The pain impulse then triggers an impulse in the sympathetic nervous system (involuntary nerves) which then returns to the original area of injury. The sympathetic nervous system initiates an inflammatory response and causes the vessels to dilate. This in turn causes swelling and severe pain. The pain then triggers another impulse causing the cycle to continue. This then results in functional loss, impairment, and further disability. Predisposing factors include a traumatic injury as well as surgery. CRPS is not caused by physiological factors; however, due to constant pain and a a change in a quality of life it has been shown to cause an increase in depression and anxiety.

Types of CRPS

CRPS Type 1: The most common of the two. No specific nerve lesion or damage is identified.

CRPS Type 2: Specific nerve lesion and/or damage identified.


  • Nerve inflammation
  • Increased pain sensitivity
  • Allodynia (triggering of a pain response from stimuli which do not normally provoke or cause pain)
  • Burning
  • Stabbing
  • Grinding
  • Throbbing
  • Sensitivity to water, touch, vibrations
  • Abnormally increased sweating
  • Changes in skin temperature (hot/cold)
  • Skin changes (bright red or violet)
  • Thinning of skin
  • Mineralization changes in bone


A diagnosis is not confirmed with a clinical examination; however, suspicion is heightened during the exam when the patient has increased or uncontrolled pain not consistent with the injury or post surgical recovery. Questions will be directed towards the symptoms of CRPS.

An Electromyography (EMG) and Nerve Conduction Studies (NCS) will be ordered to further evaluate CRPS and to confirm diagnosis.


If a diagnosis of CRPS is made a referral will be placed to the Chronic Pain Management team for further evaluation and treatment.

At times Physical Therapy can help/assist with the symptoms of CRPS to include modalities such as transcutaneous electrical nerve stimulation (TENS), progressive weight bearing, tactile desensitization, massage, and contrast bath therapy