Complex regional pain syndrome - Symptoms 

Symptoms of complex regional pain syndrome 

The main symptom of chronic regional pain syndrome (CRPS) is a severe, continuous burning pain in part or all of a limb. This could be in one of your arms, legs, hands, feet or ankles.

The pain is usually triggered by an injury, and is a lot worse than you would normally expect. For example, you may have a minor ankle sprain, but the pain can feel like a severe burn.

If you have CRPS, the skin of the affected body part can become very sensitive, and even the slightest touch, bump, or change in temperature can provoke intense pain.

You may hear this described in the following medical terms:

  • hyperalgesia – when you are extremely sensitive to pain
  • allodynia – when you feel pain from something that should not be painful at all, such as a very light touch

In more severe cases of CRPS, muscles in the affected limb may begin to waste (atrophy). This usually occurs if the person affected is unwilling to use their limb due to associated pain.

Other symptoms

CRPS can cause other symptoms, including:

  • alternating changes in skin temperature – sometimes your skin may feel sweaty, other times cold and clammy
  • changes in skin colour – your skin tone may range from pale and colourless to pink, or may have a blue tinge and appear blotchy or streaky
  • changes in skin texture – your skin may appear shiny and thin
  • changes in the way your hair and nails grow – either unusually slowly or quickly
  • swelling, pain and stiffness in the affected joints
  • increasing difficulty moving the affected body part

Stages of CRPS

Symptoms of CRPS usually progress in three distinct stages. However, not everyone will experience all possible symptoms, or progress through all three stages, which are outlined below.

Stage one

This first stage usually lasts from one to three months, and is characterised by an intense, burning pain in one of your limbs. You may experience:

  • muscle spasms (when muscles contract tightly and painfully)
  • joint stiffness
  • rapid growth of hair and nails

Blood vessels in your limb will also be affected, causing a change in skin colour and temperature.

Stage two

The second stage of CRPS usually lasts from three to six months. The pain in your affected limb may get worse, and the skin colour and texture changes may be more pronounced. Symptoms of swelling and stiffness become more severe, and muscle tone in your affected limb will begin to weaken.

Stage three

The third stage of CRPS is the last stage of the condition. At this point, any changes to your affected limb are likely to be irreversible. These may include:

  • significant loss of muscle tone 
  • bones of the limb may have become contorted (bent out of shape)
  • joints may be stiff
  • you will probably find it very difficult to use or move your limb

However, with prompt and effective treatment, it is possible to stop the progression of CRPS to its final stage, preventing irreversible damage from occurring.


Page last reviewed: 23/05/2012

Next review due: 23/05/2014

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The 7 comments posted are personal views. Any information they give has not been checked and may not be accurate.

Joton said on 10 January 2014

I broke my wrist in December 2012 and had a plaster cast put on at a local walk-in centre; two days later I attended the local hospital where they re-xrayed and decided to add a fibreglass plaster on top of the original plaster. From that day I began to experience unbelievable pain/burning. I went back to the walk-in several times, and had many hospital visits (some appointments, some unscheduled) and told various consultants/registrars/nurses about the agonising burning but nobody picked up on it. I had the plaster changed three times in all!

Just under 5 weeks after my accident I returned to the hospital yet again begging them to remove the plaster, which they did. I thought it would alleviate the terrible burning pain if I put cream on the areas but it was just as bad.

In the end we paid£450 +x-ray charges to see the head consultant of the hospital fracture clinic privately (I’d only ever seen his registrars) and he immediately diagnosed CRPS, suggesting immediate starting of physio, making sure that on future visits to the fracture clinic I would see him personally. I paid to have twice-weekly physio and stuck rigidly to what I was told to do. Fortunately I did not look up CRPS as I was frightened and depressed enough as it was!

A year later my wrist is still a bit stiff but my range is better than I could have hoped for, and I think it will improve even more. The CRPS pain is all but gone, although there is still some joint pain which I feel is normal. My consultant and physio told me that it was my sheer determination that put me in the top 5% of expected recovery. My sympathy goes out wholeheartedly to anyone suffering from this debilitating condition but there is a light at the end of the tunnel – I am testament to that. I just don’t know why none of the medical staff picked up on it – a brief description of symptoms should be sent to all fracture clinics as early diagnosis is imperative!

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K Mac said on 12 July 2013

I find the omission of other signs alarming. The effect on the autonomic and limbic systems for example. I have hypertension caused by CRPS. I have depression caused by CRPS. I am not alone, weird signs of the conditions tend to be thought of as separate when they are actually part and parcel of CRPS.

I agree with SmudgeyL: CRPS is a systemic syndrome. I find it disappointing that the NHS does not recognise this.

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K Mac said on 08 July 2013

Just to add to my previous post. I have read the bit about atrophy and the "person affected is unwilling to use their limb due to associated pain" is very unhelpful. We are talking about patients and, as NHS Choices is talking about "the most severe cases", about a degree of pain that is unimaginable to most people. Unwilling is a hurtful word and the tone of the statement suggests disability denial when actually the patient who has become one of the most severe cases is likely to be profoundly disabled (in the social model sense of disabled).

Shame the page won't be reviewed until May 2014.

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SmudgeyL said on 17 April 2013

Please note that CRPS is no longer considered to have stages.

That have discovered that CRPS is a systemic condition, which effects the whole body. Speaking 4 years ago, Dr Prager, chair of the IASP's SIG for CRPS: http://www.youtube.com/watch?v=-jLUQpaZKf8

So where are the symptoms of falling, fainting, burred vision, nausea, sleeplessness? These symptoms are recognised in medical literature but they are not getting treated as they do not appear on the NHS list.

Other symptoms patients may incur are "cognition; constitutional, cardiac, and respiratory complications; systemic autonomic dysregulation; neurogenic edema; musculoskeletal, endocrine and dermatological manifestations; as well as urological and gastrointestinal function" See Robert J. Schwartzman's paper "Systemic Complications of Complex Regional Pain Syndrome" . It is scary stuff and these symptoms are just being swept under the carpet and ignored.

Surely it is time that we patients get the legitimacy and treatment we deserve. Ignoring CRPS will not make it go away- it gets worse over time and as Dr Schwarzman notes, 35% of CRPS patients consider their symptoms to be "full body". These patients need dignity- it is not right to expect people to crawl about on hands and knees and let them fall over 6 times a day just because the NHS literature is so badly out of date it doesn't include the symptoms.

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Cgc1234 said on 02 March 2013

After an injury two yrs ago I was finally diagnosed with crps. No medication combinations have helped and now I'm having various other problems as a result of my illness.i am in constant agonising pain in both legs.i have now been referred to Walton neurological and really anxious about what lies ahead for me now.if anyone can give me an idea I wud be very grateful.

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LillyHannover said on 04 November 2011

I have a number of health problems. I have severe arthritis in my right leg and hip. I use a cane or walker most of the time. I'm on oxygen 24 x 7 for C.O.P.D., and I have been fighting with depression for 20 years. And I'm in so much pain at night that I'm up and down all night. My doctor put me on morphine 12 hour caps. Any suggestions of a friend or doctor?

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LillyHannover said on 04 November 2011

I have a number of health problems. I have severe arthritis in my right leg and hip. I use a cane or walker most of the time. I'm on oxygen 24 x 7 for C.O.P.D., and I have been fighting with depression for 20 years. And I'm in so much pain at night that I'm up and down all night. My doctor put me on morphine 12 hour caps. Any suggestions of a friend or doctor?

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