Oahu CRPS Support Group

Diagnostic and Symptomatic References

CRPS is a neuro-inflammatory disorder considered to result from a dysfunction of the peripheral and central nervous systems. The hallmark symptom is burning pain that is out of proportion to the inciting event, which is most commonly a fracture. Symptoms of CRPS can include edema, allodynia (pain to touch), hyperalgesia (severe painful response to mildly painful stimulation), temperature and color changes, muscle weakness, tremor, dystonia, muscle atrophy, and changes to the skin, hair or nails. Many CRPS patients experience insomnia, fatigue, and depression. CRPS can affect heart rate, gastric function and cause osteopenia. CRPS can spread from one extremity to another, and can affect the internal organs. CRPS is considered a syndrome rather than a disease because the cause of the disorder has not been identified. 

CRPS is divided into two presentations. CRPS Type 1 is defined as having no demonstrable nerve injury. CRPS Type 2 is defined as having a demonstrable nerve injury. Treatment is identical. However, research conducted by Anne Oaklander, MD, PhD has shown that small fiber pathology exists even in CRPS Type 1. Another concept about CRPS/RSD which has fallen out of favor is the Stages of CRPS.

Recognized since the Civil War, CRPS has been described by many different names over the years including: Causaliga, Sudeck’s Atrophy, Reflexive Sympathetic Dystrophy, and others. International diagnostic criteria were developed in 1993 called the Budapest Criteria. CRPS is diagnosed based on a physical examination. There is no test for CRPS. There is no known cure for CRPS. In the United States, it is estimated that there are 50,000 new cases every year. CPRS pain is ranked at the highest pain level according to the McGill Pain Scale.

What is CRPS?

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CRPS treatments have evolved over time. The last ten years has seen new research yielding emerging treatments for CRPS. At present, there are no FDA approved medications for the treatment of CRPS. It is important to make sure that your physician is qualified to diagnose and treat CRPS. It is estimated that the average patient sees more than four doctors before they receive a proper diagnosis!  The following recommendations are based on the lecture CRPS: Diagnosis and Management, presented by Dr. Pradeep Chopra at an RSDSA conference on 5-7-14.  Additional Clinical Treatment Guidelines can be found on the RSDSA website at: Complex Regional Pain Syndrome: Treatment Guidelines.

How is CRPS Treated?

A variety of medications are used to manage CRPS pain and other symptoms. Most of these medications are used off label because there are NO medications currently approved by the FDA for CRPS/RSD.

  • Anti-seizure medications such as Gabapentin or Pregabalin
  • Anti-depressants such as Tricyclic antidepressants, SNRIs
  • NMDA blockers such as Ketamine, Low Dose Naltrexone
  • Calcium regulating drugs such as Pamindronate, Alendronate, Neridronate
  • Muscle relaxants such as Baclofen, Tizanidine, Cyclobenzaprine
  • Clonidine
  • Vitamin C has been shown to reduce CRPS following surgery
  • Opioids are commonly prescribed, however emerging research suggests that these drugs may increase pain levels due to glial cell activation. 
  • Palmitoylethanolamide (PEA Pure)
  •  Topical medications such as DMSO or Ketamine lotions