Complex Regional Pain Syndrome (CRPS) / 
Reflex Sympathetic Dystrophy(RSD)
by Celeste Cooper

Complex regional pain syndrome (CRPS) is a very painful chronic condition characterized
by severe burning pain, pathological changes in bone and skin, excessive sweating, tissue swelling, and extreme sensitivity to touch in an upper or lower limb following injury. It is also known as: 

  • algodystrophy
  • causalgia syndrome
  • posttraumatic dystrophy
  • reflex neurovascular dystrophy
  • Steinbrocker syndrome.

…Because the symptoms of CRPS can affect the entire body, it may be confused with FM and/or CFID. The range of motion restriction may be confused with CMP [Chronic Myofascial Pain Syndrome]. The reverse is also true, in that people with FM/CMP complex are often incorrectly diagnosed as having CRPS…. {End excerpt from Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome and Myofascial Pain: The Mind-Body Connection by Celeste Cooper, RN and Jeff Miller PhD}

Suspect is a problem between the central and peripheral nervous systems and inappropriate inflammatory responses, and though it can occur at any age, it is more prevalent in mid age. These suggestions are similar to those found in fibromyalgia, chronic fatigue syndrome, and myofascial pain syndrome.  More research in this area could help unwind the mysteries at hand that are encasing so many of us in pain. 

According to Medical News Today 

Some believe that a physical injury, for example, may cause the SNS [sympathetic nervous system] to release catecholamines. (See pages 17 and 22 if you have a copy of Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome and Myofascial Pain]. 
Catecholamines are 'fight-or-flight' hormones. Due to an unknown underlying problem, catecholamines are thought to activate pain receptors. …

The sympathetic nervous system responds to danger which affects its fight or flight response, discharging chemical messengers like adrenalin (a type of catecholamine) and cortisol (known as the stress hormone) via the central to peripheral transport system.  The SNS also affects heart rate, breathing and shunting of blood from the gastrointestinal tract, and constricts blood vessels to prepare for a range of things such as exercise to emotional stress. It prepares us for any threat to the body’s well-being, known as homeostasis.  It also regulates blood vessels of the skin, which could account for the skin (noted in symptoms) changes in CRPS, similar to what happens in Raynaud’s (a vasospastic disorder caused by a hyperactive SNS), and livedo reticularis (a lacy net like modeling/discoloration usually in the legs, linked to swollen blood vessels, which may get worse when the temperature is cold, another SNS occurrence).  Raynaud’s is not an uncommon finding in fibromyalgia, and these other similar patterns could indicate a relationship of these disorders and/or cause confusion during the diagnostic process. Like fibromyalgia and chronic fatigue syndrome, some believe that Type 2 CRPS is caused by a problem with the immune system. For the sake of being redundant, how can we advocate for more research revolved around the SNS and immune systems?  Understanding these basic similarities could launch research that is beneficial to many neuro-endocrine-immune disorders.  Columbus was looking for India!

According to Mayo Clinic there are two types

Type 1. Previously known as reflex sympathetic dystrophy syndrome, this type occurs after an illness or injury that didn't directly damage the nerves in your affected limb. About 90 percent of people with complex regional pain syndrome have type 1.

Type 2. Once referred to as causalgia, this type follows a distinct nerve injury.

CRPS/RSD Symptoms:

  • Burning or throbbing pain, usually involving an extremity.
  • Hyper sensitivity to touch or cold.
  • Swelling of the painful area and joints.
  • Joint stiffness.
  • Vasomotor changes affecting skin temperature, color (mottled red or blue) and texture (tender, thin or shiny) and sometimes causing unusual sweating of the involved extremity.  
  • Changes in hair and nail growth at unusual speeds (too slow or too fast).
  • Muscle spasms and weakness.
  • Decreased mobility and function of the extremity involved.
  • Tissue wasting (atrophy).
  • Muscle tightening (contracture).
Also important to note is that symptoms can begin in a local area and spread to other parts of the body.


  • Bone scan to see if there are notable changes in the bone.
  • Sympathetic nervous system tests – the goal is to identify possible anomalies in the patient's sympathetic nervous system., which includes: the sweat test to compare a healthy limb with the one that is having symptoms, thermography which measures the temperature, and electrodiagnostic testing where electrical activity is measured and compared. If this is abnormal consideration of type 2 CRPS is given.
  • X-rays to detect any mineral loss.
  • Magnetic resonance imaging (MRI), to show tissue changes or rule out another causes.
  • Blood tests to rule out other causes.
  • Biopsy to check for cancer cells as a cause of symptoms.


As with any disorder for which we do not know the cause (syndrome), treatment goals are to minimize symptoms.  Because the cause is unknown, minimizing symptoms and learning to cope in a healthy manner.  

Treatment consists of:

  • Physical therapy
  • Topical treatments
  • Heat or cold therapy, depending on personal tolerance
  • TENS units
  • Medications, including sympathetic nerve blocking agents
  • In some cases implanted spinal cord stimulator.
  • Meeting physical, mental, emotional and spiritual needs, frequently overlooked, but imperative to balance and feelings of well-being.  
Chronic pain from any source takes a toll on all aspects of being.  It is a dragon breathing fire and destruction of everything in its path, but as patients, we can learn to fight the monster by using the tools we have.  Many of the integrative therapies in our big book can help with that, and our new book, soon to be released, Broken Body, Wounded Spirit: Balancing the See Saw of Chronic Pain, Fall Devotions, was written with every pain patient in mind.  It is a journey, and each day a challenge, but each day is a new day, and every day has something positive to offer us, we just have to look a little harder for it sometimes.

See the helpful links for information and links regarding CRPS/RSD Reflex Sympathetic Dystrophy Syndrome Association

In healing and hope, Celeste

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This website receives no revenue. Income generated from book sales is used to provide a free blog, reimbursement for expenses related to advocacy, and volunteer education pieces as health expert for Celeste Cooper hopes you find the content of this website, her blog, her answers on Sharecare, links to her advocacy work through, and her books helpful in your journey.
Read more about the books:

Broken Body Wounded Spirit, Balancing the See-Saw of Chronic PainSpring Devotions 

Broken Body Wounded Spirit, Balancing the See-Saw of Chronic Pain
Winter Devotions

Broken Body Wounded Spirit, Balancing the See-Saw of Chronic Pain, Summer Devotions (here).

Broken Body Wounded Spirit, Balancing the See-Saw of Chronic Pain, Fall Devotions (here).

Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome and Myofascial Pain: The Mind-Body Connection (here).

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