Massage therapy · Kitchener–WaterlooComplex Regional Pain Syndrome

Complex regional pain syndrome (CRPS) is an uncommon type of long-term (chronic) pain that usually affects one arm or leg. It normally develops after an injury, but the pain is much more severe and long-lasting than you would expect from the original injury (NHS, 2022a). The cause isn't clearly understood. Treatment tends to work best when it starts early, and improvement is entirely possible: around 85% of people find their pain and some other symptoms slowly ease within the first 2 years (NHS, 2022c).

CRPS usually develops within a month of an injury to the limb, which can be minor or more serious, such as a broken bone (fracture), a sprain or strain, a burn or a cut. It has also been known to happen after surgery to a limb, or after a limb has been kept still for a while (for example in a plaster cast) (NHS, 2022b). Most people recover from these injuries as expected, but people with CRPS develop pain that is far worse and lasts much longer than normal.

The skin of the affected area can become so sensitive that even a light touch, a bump or a change in temperature causes intense pain. The limb may also become swollen or stiff, or change in colour or temperature (NHS, 2022a). Some people still call CRPS by its older name, reflex sympathetic dystrophy (RSD) (American Academy of Orthopaedic Surgeons, n.d.). CRPS can be very painful, and finding the right mix of treatments can take time, so care usually involves several different professionals working together (NHS, 2022c).

Complex Regional Pain Syndrome Anatomy

CRPS usually affects one limb after an injury to that limb. Its exact cause is unknown. One of the main theories is that the body reacts abnormally to an injury, causing several of the body's systems to malfunction (NHS, 2022b). Experts think this involves the nerves in the limb (the peripheral nervous system) as well as the brain and spinal cord (the central nervous system). One theory describes a "short circuit" that makes the part of the nervous system that controls blood flow and sweating in the limb overactive (American Academy of Orthopaedic Surgeons, n.d.).

How to Manage Complex Regional Pain Syndrome

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

• CRPS is complicated and usually needs specialist care from a team, which may include a physiotherapist, an occupational therapist, a pain specialist, a psychologist and your family doctor or nurse practitioner (NHS, 2022c).
• See your family doctor or nurse practitioner as soon as possible if you have persistent pain that is stopping you doing everyday activities, as early treatment may help reduce your symptoms (NHS, 2022a).
• Living with long-term pain can affect your mood. If you are feeling low or having thoughts of harming yourself, speak to your family doctor or nurse practitioner as soon as possible (NHS, 2022a).
• Injuries such as fractures, sprains, burns and cuts, as well as surgery or a limb being kept in a cast, can all come before CRPS (NHS, 2022b). Infection, stroke and heart attack have also been linked to it (American Academy of Orthopaedic Surgeons, n.d.).

With CRPS, the nervous system around the injured limb has turned its alarm up too high, so even light touch can hurt. Your family doctor or nurse practitioner and your care team lead your treatment, and I work alongside them. If CRPS followed surgery, I need your surgeon's okay before any hands-on treatment. Everything we do stays within what you can tolerate, because pushing through pain makes the sensitivity worse.

I start by asking what your team has advised, then gently assessing how the limb moves, how sensitive the skin is, and how the rest of your body is coping.

In the Clinic

• A slow, relaxing massage to settle the stress response, working around the sore area if direct touch flares it
• Gentle lymphatic drainage with the limb raised to help with swelling
• Easing the neck, shoulders, back or other limbs that work overtime while you protect the sore one
• Gentle scar work if you had surgery or a wound, once healed and only as far as you can tolerate
• Moving each joint gently with you helping, within a comfortable range

At Home

1. NHS (2022a) Complex regional pain syndrome. Available at: https://www.nhs.uk/conditions/complex-regional-pain-syndrome/ (Accessed: 7 October 2026).
2. NHS (2022b) Complex regional pain syndrome – Causes. Available at: https://www.nhs.uk/conditions/complex-regional-pain-syndrome/causes/ (Accessed: 7 October 2026).
3. NHS (2022c) Complex regional pain syndrome – Treatment. Available at: https://www.nhs.uk/conditions/complex-regional-pain-syndrome/treatment/ (Accessed: 7 October 2026).
4. American Academy of Orthopaedic Surgeons (n.d.) Complex regional pain syndrome (reflex sympathetic dystrophy). OrthoInfo. Available at: https://www.orthoinfo.org/diseases--conditions/complex-regional-pain-syndrome-reflex-sympathetic-dystrophy/ (Accessed: 7 October 2026).
5. Goebel, A., Barker, C., Turner-Stokes, L. et al. (2018) Complex regional pain syndrome in adults: UK guidelines for diagnosis, referral and management in primary and secondary care. 2nd edn. London: Royal College of Physicians. Available at: https://www.rcp.ac.uk/media/4uijppdz/complex-regional-pain-syndrome-in-adults-second-edition_0.pdf (Accessed: 7 October 2026).