Complex Regional Pain Syndrome (CRPS) is a chronic, often progressive pain condition that most commonly affects a limb after injury, surgery, stroke, or prolonged immobilization. It typically presents in the hands, arms, feet, or legs with burning pain, swelling, color and temperature changes, and movement difficulties; less commonly it can affect the face, torso, or bilateral limbs. Triggers include obvious tissue trauma (fractures, sprains), surgical procedures, infections, casts or prolonged immobilization, and sometimes more subtle triggers such as minor nerve injuries or severe emotional or physical stress. Unusual presentations and rare triggers—vaccination, minor needle punctures, or visceral disease—are reported in case studies but are uncommon.
In my case, after my two complete knee replacement surgeries, several years ago, I was healing quite well, with full yoga mobility again, but the feeling from my knees to the feet was as if I had sunburn, all of the time. When I pressed my finger on my lower legs, a white fingerprint popped up, like I had been at the beach all day without my sunscreen. After a few months of recovery after surgeries, I went to the surgeon. He told me that CRPS was common after surgery. My nervous system was overactive in those areas. Emotional turmoil can trigger flare ups or increases of symptoms if one has CRPS 24/7 like I did. I also had numbness and tingling in the outer half of my feet, bilaterally. It is 5 years post-first-knee surgery, and I still have CRPS. With my newly diagnosed hyperthyroidism, my entire body now has the skin feeling like I have a sunburn. So, the whole central nervous system is overactive, caused by my overactive thyroid. Lucky me...I'm on fire!
CRPS incidence estimates vary (roughly 5–26 new cases per 100,000 people per year) and it most often affects women, with studies showing women are 3–4 times more likely to develop CRPS than men, and peak onset occurs in middle age. Diagnosis uses clinical criteria because no single test is diagnostic; delayed diagnosis is common and contributes to poorer outcomes. The condition can cause major functional loss and comorbid mood disturbance; early recognition and a multidisciplinary plan improve chances of recovery.
Treatment is multidisciplinary and individualized: active physical and occupational therapy (graded exercise, desensitization, mirror therapy, graded motor imagery), neuropathic and multimodal medications (gabapentin, pregabalin, certain antidepressants, judicious opioids), sympathetic blocks, spinal cord stimulation, and psychological therapies (CBT, pain coping skills). Some clinics offer less‑conventional or “unusual” therapies—high-dose vitamin C prophylaxis after fracture, bisphosphonates, topical ketamine, hyperbaric oxygen, or complementary approaches (acupuncture, psychotherapy, TENS)—with variable evidence; such options are generally considered when standard treatments fail and are best delivered within specialist centers.
Intravenous ketamine is used in Australia for refractory CRPS in specialist pain services and some private clinics; protocols vary but typically involve monitored infusions (low to moderate dose infusions over hours to days, sometimes repeated or as an inpatient under anesthetic supervision). Evidence shows ketamine can reduce pain and improve function for some patients, though effects may be temporary and risks (dissociation, cardiovascular effects, bladder toxicity with long-term use) require careful screening and monitoring. If considering ketamine, seek an experienced pain specialist to discuss likely benefits, risks, setting (inpatient vs outpatient), costs, and follow‑up. (FYI: In the USA, ketamine therapy has been used for depression in an in-patient injection setting while the patient is in an acute psychiatric setting.)
If any of these signs or symptoms plague your everyday life, and affect your quality of life, seek out professional help. For me, I am doing the best I can to manage the symptoms, and distracting myself from feeling sorry for myself with large doses of mindfulness, meditation, Gabapentin, yoga, hiking, loving relationships, prayer, and laughter.
I hope this information has helped you or those you care for in any way.
In Gratitude,
KJ Landis
@superiorself on Instagram and X
@SuperiorSelf channel on YouTube
@superiorselfwithkjlandis on TikTok
[email protected]
Books available everywhere!
Bibliography
- Harden RN, Bruehl S, Stanton-Hicks M, Wilson PR. Proposed new diagnostic criteria: Complex Regional Pain Syndrome. Pain Medicine. 2007; (Budapest Criteria).
- de Mos M, et al. The incidence of complex regional pain syndrome: a population-based study. Pain. 2007;129(1-2):12–20.
- Bruehl S. Complex regional pain syndrome. BMJ. 2015;351:h2730 (review of epidemiology and management).
- Goebel A. Complex regional pain syndrome in adults. Rheumatology (Oxford). 2011;50(10):1739–1750.
- Maneksha GS, et al. Intravenous ketamine for CRPS: systematic reviews and clinical reports (see national pain service guidelines). Australian and international pain-management center protocols (consult local specialist services for current Australian ketamine protocols and availability).
- Harden RN, Oaklander AL, Burton AW, et al. Complex regional pain syndrome: practical diagnostic and treatment guidelines, 4th edition. Pain Med. 2013;14(2):180–229.
In my case, after my two complete knee replacement surgeries, several years ago, I was healing quite well, with full yoga mobility again, but the feeling from my knees to the feet was as if I had sunburn, all of the time. When I pressed my finger on my lower legs, a white fingerprint popped up, like I had been at the beach all day without my sunscreen. After a few months of recovery after surgeries, I went to the surgeon. He told me that CRPS was common after surgery. My nervous system was overactive in those areas. Emotional turmoil can trigger flare ups or increases of symptoms if one has CRPS 24/7 like I did. I also had numbness and tingling in the outer half of my feet, bilaterally. It is 5 years post-first-knee surgery, and I still have CRPS. With my newly diagnosed hyperthyroidism, my entire body now has the skin feeling like I have a sunburn. So, the whole central nervous system is overactive, caused by my overactive thyroid. Lucky me...I'm on fire!
CRPS incidence estimates vary (roughly 5–26 new cases per 100,000 people per year) and it most often affects women, with studies showing women are 3–4 times more likely to develop CRPS than men, and peak onset occurs in middle age. Diagnosis uses clinical criteria because no single test is diagnostic; delayed diagnosis is common and contributes to poorer outcomes. The condition can cause major functional loss and comorbid mood disturbance; early recognition and a multidisciplinary plan improve chances of recovery.
Treatment is multidisciplinary and individualized: active physical and occupational therapy (graded exercise, desensitization, mirror therapy, graded motor imagery), neuropathic and multimodal medications (gabapentin, pregabalin, certain antidepressants, judicious opioids), sympathetic blocks, spinal cord stimulation, and psychological therapies (CBT, pain coping skills). Some clinics offer less‑conventional or “unusual” therapies—high-dose vitamin C prophylaxis after fracture, bisphosphonates, topical ketamine, hyperbaric oxygen, or complementary approaches (acupuncture, psychotherapy, TENS)—with variable evidence; such options are generally considered when standard treatments fail and are best delivered within specialist centers.
Intravenous ketamine is used in Australia for refractory CRPS in specialist pain services and some private clinics; protocols vary but typically involve monitored infusions (low to moderate dose infusions over hours to days, sometimes repeated or as an inpatient under anesthetic supervision). Evidence shows ketamine can reduce pain and improve function for some patients, though effects may be temporary and risks (dissociation, cardiovascular effects, bladder toxicity with long-term use) require careful screening and monitoring. If considering ketamine, seek an experienced pain specialist to discuss likely benefits, risks, setting (inpatient vs outpatient), costs, and follow‑up. (FYI: In the USA, ketamine therapy has been used for depression in an in-patient injection setting while the patient is in an acute psychiatric setting.)
If any of these signs or symptoms plague your everyday life, and affect your quality of life, seek out professional help. For me, I am doing the best I can to manage the symptoms, and distracting myself from feeling sorry for myself with large doses of mindfulness, meditation, Gabapentin, yoga, hiking, loving relationships, prayer, and laughter.
I hope this information has helped you or those you care for in any way.
In Gratitude,
KJ Landis
@superiorself on Instagram and X
@SuperiorSelf channel on YouTube
@superiorselfwithkjlandis on TikTok
[email protected]
Books available everywhere!
Bibliography
- Harden RN, Bruehl S, Stanton-Hicks M, Wilson PR. Proposed new diagnostic criteria: Complex Regional Pain Syndrome. Pain Medicine. 2007; (Budapest Criteria).
- de Mos M, et al. The incidence of complex regional pain syndrome: a population-based study. Pain. 2007;129(1-2):12–20.
- Bruehl S. Complex regional pain syndrome. BMJ. 2015;351:h2730 (review of epidemiology and management).
- Goebel A. Complex regional pain syndrome in adults. Rheumatology (Oxford). 2011;50(10):1739–1750.
- Maneksha GS, et al. Intravenous ketamine for CRPS: systematic reviews and clinical reports (see national pain service guidelines). Australian and international pain-management center protocols (consult local specialist services for current Australian ketamine protocols and availability).
- Harden RN, Oaklander AL, Burton AW, et al. Complex regional pain syndrome: practical diagnostic and treatment guidelines, 4th edition. Pain Med. 2013;14(2):180–229.
RSS Feed