Complex Regional Pain Syndrome (CRPS)
One of the most misunderstood conditions in medicine — and one we have spent decades helping to define and treat.
Complex Regional Pain Syndrome (CRPS) is a symptom. The source is the answer.
Complex Regional Pain Syndrome is a chronic pain condition that typically develops after an injury, surgery, or trauma — often one that seemed minor. The pain becomes wildly disproportionate to the original injury, and the affected limb may change color, temperature, or sweating pattern, become swollen, and grow so sensitive that a bedsheet or a breeze is unbearable.
CRPS is frequently missed, dismissed, or misdiagnosed for months or years. Patients are told the pain is out of proportion, that nothing is wrong, or that it is psychological. It is none of those things. It is a real disorder involving the sympathetic nervous system, inflammation, and central sensitization — and early, accurate treatment dramatically changes the outcome.
National Pain Centers has extraordinary depth here. Dr. Joshi is a published co-architect of the landmark unifying theory connecting the stellate ganglion block to CRPS, and he built America’s first surgery-center-based outpatient ketamine infusion program, treating CRPS among its primary indications.
The delay is the tragedy. Studies and clinical experience alike suggest that patients treated early — within weeks to months of onset — do substantially better than those treated after a year of being told nothing is wrong. Yet the average CRPS patient spends a long time being disbelieved before anyone names the condition.
Part of that is genuine diagnostic difficulty: CRPS has no confirmatory blood test, no definitive scan. It is a clinical diagnosis, made by a physician who recognizes the pattern. Part of it, though, is that a limb that hurts far more than it should makes physicians uncomfortable — and discomfort too often becomes dismissal.
Time matters in CRPS. Every month of delay makes it harder to treat — which is why the delay in diagnosis is the greatest harm most patients suffer.
What can cause complex regional pain syndrome (crps)
Below are the conditions we most commonly identify and treat. Many patients have more than one contributing source at the same time — which is precisely why careful diagnosis matters.
Understanding CRPS
CRPS Type I (Reflex Sympathetic Dystrophy)
Develops after an injury with no confirmed nerve damage. The inciting event is often minor — a sprain, a fracture, even a needle stick — yet the resulting pain and dysfunction are severe.
CRPS Type II (Causalgia)
Develops after a confirmed nerve injury. The features are similar, but a specific damaged nerve is identifiable.
Sympathetic Nervous System Dysfunction
The sympathetic nervous system becomes abnormally involved in pain signaling, driving the color, temperature, and sweating changes that characterize CRPS — and offering a specific therapeutic target.
Central Sensitization
The nervous system amplifies pain signaling until light touch becomes agonizing (allodynia) and painful stimuli become unbearable (hyperalgesia). This is why CRPS pain spreads and outlasts any tissue injury.
Common Triggers
Fracture, Sprain & Crush Injury
The most common precipitants. Notably, severity of the original injury does not predict who develops CRPS.
Post-Surgical CRPS
Can follow any surgery, including minor procedures — carpal tunnel release, arthroscopy, or fracture fixation.
Nerve Injury or Compression
Direct nerve trauma, entrapment, or traction injury can initiate CRPS Type II.
Prolonged Immobilization
Extended casting or disuse can contribute, which is why appropriate early movement matters after injury.
Signs, Symptoms & Progression
Allodynia & Hyperalgesia
Pain from stimuli that should not hurt — clothing, air movement, light touch — and exaggerated pain from stimuli that should hurt only a little.
Color, Temperature & Sweating Changes
The limb may appear red, blue, mottled, or pale; feel hot or cold; and sweat abnormally. These autonomic signs are hallmarks of the condition.
Swelling, Stiffness, Weakness & Tremor
Edema, reduced range of motion, weakness, dystonia, or tremor in the affected limb, often with nail and hair growth changes.
Spread & Chronicity
Untreated, CRPS can spread to other limbs and become entrenched. This is the central reason we treat aggressively and early rather than waiting to see.
Living With CRPS & What Recovery Requires
Disuse & Deconditioning
Pain drives patients to protect the limb, and protection drives stiffness, weakness, and further pain. Breaking this cycle with carefully dosed movement is essential — and it usually requires interventional pain relief to make movement tolerable in the first place.
Sleep Disruption
CRPS pain destroys sleep, and poor sleep amplifies central sensitization. Addressing sleep is not adjunctive care; it directly modulates the mechanism driving the pain.
The Toll of Being Disbelieved
Anxiety and depression are common in CRPS — as consequences of severe, unrelenting, dismissed pain, not as its cause. Whole-person support is part of treatment, and it should never be offered as a substitute for treating the pain.
What Recovery Actually Looks Like
Meaningful improvement is achievable, particularly with early treatment. Recovery generally requires combining interventional pain relief with aggressive rehabilitation, sleep restoration, and support — no single treatment does it alone.
When to seek urgent evaluation
CRPS is not usually a 911 emergency, but it is a time-sensitive one. Seek prompt evaluation if you have disproportionate pain after an injury or surgery, especially with swelling, color or temperature change, or extreme sensitivity to touch. Early treatment substantially improves outcomes. Call 911 for signs of infection, sudden loss of circulation, or a limb that is cold and pulseless.
Diagnosis is a procedure, not a guess
Imaging alone rarely provides the answer. Findings of degeneration are extraordinarily common in people with no pain whatsoever — so an abnormal image doesn’t prove we’ve found the culprit. Conversely, some of the most treatable causes may not appear on imaging at all.
So we build the diagnosis from several converging sources:
01 — A genuinely thorough history and physical examination
CRPS is a clinical diagnosis. It is made by an experienced physician who recognizes the pattern — sensory, autonomic, motor, and trophic changes disproportionate to the inciting event. There is no single confirmatory blood test.
02 — Application of validated diagnostic criteria
We apply established clinical criteria rigorously rather than labeling any painful limb as CRPS. Accurate diagnosis in both directions matters: over-diagnosis harms patients as surely as under-diagnosis.
03 — Correlated imaging and testing when indicated
Imaging and nerve testing are used to identify or exclude other causes and to characterize a nerve injury — not to “prove” CRPS, which they cannot do.
04 — Diagnostic sympathetic blocks
A sympathetic block, such as a stellate ganglion or lumbar sympathetic block, can both confirm the sympathetic component of your pain and provide therapeutic relief.
This is the difference between treating a picture and treating a patient. We confirm the source before committing you to a therapeutic procedure.
Precise, non-opioid, physician-performed care
Once we know the source, treatment can be targeted. Every procedure is performed personally by Dr. Joshi, using low-dose imaging, non-opioid sedation when appropriate, and hand-selected medications and products. We do not delegate procedures, and we do not use opioids as a treatment strategy.
Stellate Ganglion Blocks
For CRPS affecting the upper extremity, face, or head. Blocking this sympathetic nerve cluster in the neck can interrupt the sympathetic contribution to pain, often producing meaningful relief and enabling rehabilitation.
Dr. Joshi is a published co-author and co-architect of the landmark 2009 unifying theory (Lipov, Joshi, Sanders & Slavin) connecting the stellate ganglion block across CRPS, hot flashes, and PTSD through a shared sympathetic mechanism — one of the most cited theoretical contributions in interventional pain.
Lumbar Sympathetic Blocks
For CRPS affecting the lower extremity. The same principle applied to the sympathetic chain in the lumbar spine, both diagnostic and therapeutic.
Ketamine Infusion Therapy
Among the most effective treatments available for CRPS. Ketamine acts on the NMDA receptor to reduce central sensitization — the amplified nervous-system signaling that drives CRPS pain.
Roughly two decades ago, when fewer than five outpatient ketamine programs existed nationwide and none were surgery-center-based, Dr. Joshi built the first — with surgical-grade safety infrastructure. Thousands of infusions later, it is still running, with CRPS among its primary indications.
Peripheral & Sympathetic Nerve Blocks
Targeted blocks of specific involved nerves to reduce pain and permit the movement and therapy essential to recovery.
Regenerative & Adjunctive Interventional Options
For appropriate candidates, additional interventional approaches can address contributing structural pain generators that perpetuate the CRPS cycle.
Aggressive, Early Rehabilitation
Movement is medicine in CRPS. Desensitization, graded motor imagery, mirror therapy, and progressive loading are essential — and our multi-disciplinary team integrates them with interventional care rather than treating them as an afterthought.
Whole-Person & Behavioral Support
CRPS affects sleep, mood, and function profoundly. Treating the person, not only the limb, is not a nicety — it changes outcomes.
Treating Coexisting Structural Pain Generators
CRPS frequently coexists with an untreated facet joint, nerve entrapment, or joint injury that perpetuates the pain cycle. Identifying and treating those sources can meaningfully lower the overall pain burden.
Coordination With Your Broader Care Team
CRPS recovery requires interventional physicians, therapists, and often behavioral health working in concert. Our multi-disciplinary team coordinates that care rather than leaving patients to assemble it themselves.
We don't rush to implant
A spinal cord stimulator is a legitimate tool for the right patient at the right time. But it’s an implant, and we treat it as a genuine last resort — not an early default reached for after a couple of quick attempts. First we find the root cause, address it, and rehabilitate it. Only when the better options are truly exhausted do we consider going there.
The same procedure is not the same procedure
Two practices can list the same procedure on a website and deliver profoundly different experiences, risks, and outcomes. Here is what changes when the details are done right.
Performed personally by Dr. Joshi
Never delegated to a technician, resident, or rotating staff. You’re treated by the physician who developed and teaches the technique — and in image-guided procedures, the difference between physicians is measured in millimeters.
Dramatically less radiation
Pulsed, low-dose imaging and a few precisely targeted spot images instead of continuous live X-ray. Based on our own procedural dose data, this reduces radiation exposure by at least 50% — and often far more — versus conventional continuous fluoroscopy, with no compromise in accuracy. For conditions treated repeatedly over years, that difference compounds.
Non-opioid sedation
When sedation is used, we use ketamine-based sedation, not fentanyl. Opioid sedation exposes you to unnecessary opioids, can complicate workplace drug testing, and can actually increase pain sensitivity. Ketamine can do the opposite.
Smaller needles, tissue-sparing lesions
Precision means we don’t need to be destructive to be effective — smaller-gauge needles and lower-temperature, longer-duration ablation that spares the healthy tissue around the target.
We actually numb you first
Thorough local anesthesia of skin and underlying tissue before the procedure begins. It takes an extra minute. We take it.
Independent, and obsessive about quality
Nearly four out of five U.S. physicians now answer to a corporate owner. We’re physician-owned, so our only incentive is your outcome. What a practice refuses to do tells you as much as what it offers.
Complex Regional Pain Syndrome (CRPS), answered
CRPS is a real, physiological disorder involving the sympathetic nervous system, inflammation, and central sensitization. The suggestion that it is psychological has harmed countless patients and delayed treatment. Distress is a consequence of severe chronic pain, not its cause.
The severity of the inciting injury does not predict CRPS. It can follow a sprain, a needle stick, or a minor surgery. That mismatch between injury and symptoms is itself a diagnostic feature — and unfortunately, it is also why so many patients are disbelieved.
As soon as possible. CRPS becomes progressively harder to treat the longer it persists, and it can spread. Early sympathetic blocks, ketamine when appropriate, and aggressive rehabilitation dramatically improve the trajectory.
An injection near a cluster of sympathetic nerves in the neck, used to interrupt the sympathetic contribution to pain in upper-extremity CRPS and related conditions. Dr. Joshi is a published co-architect of the foundational theory explaining why this block works across several seemingly unrelated conditions.
Ketamine addresses central sensitization — the amplified nervous-system signaling central to CRPS — by acting on the NMDA receptor. It is one of the most valuable tools available. We built America’s first surgery-center-based outpatient ketamine program, with CRPS among its primary indications, and have delivered thousands of infusions. Individual results vary.
Not as a first step. A stimulator is a legitimate option for carefully selected patients, but it is an implant, and we treat it as a genuine last resort. We first pursue sympathetic blocks, ketamine, and aggressive rehabilitation — approaches that carry far less risk and often succeed.
It can, particularly when untreated. This is one of the most important reasons to treat early and aggressively rather than adopting a wait-and-see approach.
Some patients achieve full remission, particularly with early treatment. Others achieve substantial improvement in pain and function. The strongest predictor of a good outcome is how quickly effective treatment begins — which is why the delay in diagnosis is the greatest harm most patients suffer. Individual results vary.
Because CRPS produces pain out of all proportion to the visible injury, and because no blood test or scan confirms it. It is a clinical diagnosis requiring a physician who knows the pattern. Being disbelieved is not evidence that your pain isn’t real — it is evidence that the right examination hasn’t happened yet.
Essentially, yes. Reflex sympathetic dystrophy (RSD) is the older term for what is now called CRPS Type I. The name changed as understanding of the condition improved.
Find out what's actually causing your pain.
A precise diagnosis is the beginning of a real solution. Let’s find your pain generator — and treat it.
This page is provided for general educational purposes and does not constitute medical advice, diagnosis, or treatment, nor does it create a physician-patient relationship. Individual results vary, and no specific outcome is promised or guaranteed. Radiation-reduction figures reflect National Pain Centers’ own procedural dose data compared with conventional continuous-fluoroscopy technique. Certain regenerative therapies are considered emerging or investigational and are not FDA-approved for all uses. Always consult a qualified physician regarding your medical condition. If you are experiencing a medical emergency, call 911.