Complex Regional Pain Syndrome: Recognition, Desensitization and Functional Rehabilitation

Recognition

CRPS is characterized by continuing regional pain disproportionate to the usual course of an inciting event together with sensory, vasomotor, sudomotor/oedema and motor/trophic features. Diagnosis is clinical and requires exclusion of better explanations.

Assessment and differential

• Map sensory change, allodynia and hyperalgesia.
• Observe temperature or colour asymmetry, swelling and sweating changes.
• Assess movement, weakness, tremor/dystonia and trophic change.
• Consider infection, vascular pathology, nerve injury, fracture complications and inflammatory disorders.

Management

Early rehabilitation aims to restore safe use of the limb. Education, graded movement, desensitization, functional task practice and psychological support may be combined with medical pain management. Avoid repeated aggressive treatment that reinforces threat or causes prolonged flares.

Progression

• Begin with tolerable sensory and movement exposure.
• Increase active range, weight bearing and task complexity gradually.
• Use function and recovery to guide dose rather than chasing zero pain before progression.
• Escalate multidisciplinary input when disability remains severe or diagnosis is uncertain.

Common mistakes

• Calling any severe post-injury pain CRPS.
• Immobilizing indefinitely because movement hurts.
• Using forceful desensitization that repeatedly provokes major flares.

Clinical pearls

• CRPS is a pattern diagnosis, not a pain score.
• Restore use gradually.
• Coordinate rehabilitation with medical and psychological care when needed.

Concise summary

CRPS rehabilitation combines careful differential diagnosis with graded sensory and functional restoration, aiming to reduce disability without reinforcing fear or prolonged avoidance.