Complex Regional Pain Syndrome: What to Do When Pain Burns After an Injury

When you break a wrist, sprain an ankle, or have surgery, you expect pain to fade over time. But what if the pain doesn’t just stick around-it gets worse? What if your skin feels like it’s on fire from the lightest touch, or your hand swells up and turns blotchy for no clear reason? This isn’t normal healing. This could be Complex Regional Pain Syndrome-a condition that turns a minor injury into a lifelong battle with pain.

It’s Not Just Pain. It’s a Nervous System Gone Wild

CRPS isn’t like a regular ache. It’s not caused by ongoing tissue damage. It’s caused by your nervous system misfiring. After an injury-even a small one like a cut or a bruise-your body’s alarm system gets stuck on high. The nerves that normally warn you of danger start screaming nonstop, even when there’s no threat. The result? Burning, stabbing, electric shock-like pain that’s way out of proportion to what happened.

Most cases start after a fracture, especially in the wrist. About 40% of CRPS cases follow a broken bone. But it can also start after surgery, a deep cut, or even a minor sprain. Sometimes, there’s no obvious injury at all. That’s part of what makes it so confusing. The pain doesn’t match the event. And that’s why so many people are told it’s "all in their head"-until they’re diagnosed correctly.

What Does CRPS Actually Feel Like?

People describe it in the same ways over and over:

• A constant burning or searing pain deep in the limb
• Skin that’s so sensitive, even a bedsheet or breeze causes agony
• Swelling, shiny or thin skin that changes color-red, purple, or pale
• Temperature differences: one hand or foot feels much colder or warmer than the other
• Nails that grow fast or become brittle
• Stiff joints, muscle spasms, or shaking
• Losing fine control-like struggling to button a shirt or pick up a coin

These symptoms don’t show up all at once. They often start weeks after the injury. The first stage can begin as early as four to six weeks later. That’s a key red flag. If you’re still in intense pain after a month, especially with any of these skin or temperature changes, you need to ask about CRPS.

Who Gets CRPS-and Why?

It’s not random. Women are three times more likely to develop it than men. Most cases happen between ages 40 and 60, but teenagers and younger adults can get it too. There’s no single cause, but researchers think it’s a mix of things:

• Damage to tiny nerve fibers that control pain and temperature
• Local inflammation that doesn’t shut off
• Overactive sympathetic nervous system (the part that handles stress responses)
• Possible autoimmune reaction-some patients have antibodies that attack their own nerves

Why do some people get it and others don’t? No one knows for sure. Genetics might play a role. So might how your brain processes pain. People with anxiety or depression aren’t more likely to get CRPS-but once they do, the emotional toll is heavy. Chronic pain rewires the brain. Sleep suffers. Depression creeps in. Daily life shrinks. That’s why treating CRPS isn’t just about drugs-it’s about the whole person.

Diagnosis: No Scan Can Prove It

There’s no X-ray, MRI, or blood test that confirms CRPS. Doctors use the Budapest Criteria-a set of clinical signs. If you have:

• Pain that’s disproportionate to the injury
• At least one symptom in three of these four categories: sensory (like burning or sensitivity), vasomotor (temperature or color changes), sudomotor/edema (swelling or sweating), and motor/trophic (weakness, tremors, or nail/hair changes)
• No other condition that explains it

Then CRPS is likely. Early diagnosis is everything. If you wait six months, the condition becomes harder to reverse. That’s why so many people suffer for years before getting the right diagnosis. If your doctor dismisses your pain as "normal healing," ask for a referral to a pain specialist or neurologist.

What Works? Treatment That Actually Helps

There’s no magic cure. But early, aggressive treatment can stop CRPS from becoming permanent. The goal isn’t just to reduce pain-it’s to retrain your nervous system.

Physical therapy is the #1 treatment. Not rest. Not avoiding movement. Movement. Gentle, guided exercises help your brain unlearn the pain signals. A therapist will work with you to slowly increase motion without triggering flare-ups. Many patients say this is the most helpful thing they’ve done-even more than medication.

Medications help too, but they’re not a fix. NSAIDs like ibuprofen may help in the early inflammatory stage. Corticosteroids (like prednisone) can reduce swelling and pain if started within the first few months. For nerve pain, drugs like gabapentin or pregabalin are often used. Antidepressants like amitriptyline or duloxetine can help with both pain and mood.

Nerve blocks can give temporary relief. Injecting numbing medicine near the affected nerves can reset the system. Spinal cord stimulators-tiny devices implanted near the spine-send electrical pulses that interrupt pain signals. Some patients get years of relief from these.

Emerging treatments are showing promise. Ketamine infusions, low-dose immunotherapy, and even virtual reality therapy are being tested. A 2022 study found autoantibodies in about 30% of CRPS patients, pointing toward future blood tests and targeted treatments.

What Doesn’t Work-and What to Avoid

Avoid long-term opioid use. They don’t work well for nerve pain and carry serious risks. Don’t wait to see if it gets better. CRPS doesn’t usually go away on its own. And don’t stop moving. Immobilizing the limb with a cast or sling for too long can make it worse.

Also, don’t ignore mental health. Pain changes your brain. Therapy-especially cognitive behavioral therapy (CBT)-helps you manage the fear, frustration, and isolation that come with chronic pain. You’re not weak for needing it. You’re smart.

Can You Get Better?

Some people recover fully within a year, especially if treatment starts early. Others live with pain for decades. The key is timing. If you start physical therapy and other treatments within the first three months, your chances of recovery jump dramatically. After a year, the condition becomes more fixed. But even then, progress is possible.

CRPS isn’t a death sentence. It’s a challenge. And like any challenge, it’s easier to face with the right team: a pain specialist, a physical therapist, a psychologist, and a doctor who listens. You’re not alone. Thousands of people have walked this path-and many have found ways to live well again.

What’s Next If You Suspect CRPS?

If you’ve had an injury and now have burning pain, skin changes, or extreme sensitivity:

1. Write down your symptoms: when they started, what makes them better or worse
2. Ask your doctor: "Could this be CRPS?" and request a referral to a pain clinic
3. Start gentle movement now-even if it hurts a little
4. Find a specialist who understands CRPS-not just a general pain doctor
5. Don’t wait. Three months is the window.

The sooner you act, the more control you have. CRPS doesn’t have to define your life. But ignoring it? That’s when it wins.