---
title: "Complex Regional Pain Syndrome"
---
## When the Pain Doesn't Match the Injury
You probably remember the original event. A fall. A sprain. A fracture. A surgery. Maybe even something minor. The injury was supposed to heal in weeks, but something went wrong. Instead of resolving, the pain became worse. It stopped fitting the injury. It spread beyond what made anatomical sense. The skin around the affected area changed, becoming more sensitive, sometimes changing color or temperature, sometimes swelling.
If this describes your experience, you may have Complex Regional Pain Syndrome, often called CRPS or RSD (the older name, Reflex Sympathetic Dystrophy). It is one of the most severe pain conditions known to medicine, and one of the most under-recognized. Many patients spend years being told their pain is exaggerated or unexplainable before someone correctly identifies CRPS. We take it seriously. The pain is real, the underlying mechanism is real, and there are specific evidence-based treatments that often produce meaningful relief, particularly when started earlier.
## What CRPS Actually Is
CRPS is a chronic pain condition that typically develops after an injury, surgery, or other trigger, with pain disproportionate to the original injury that persists or worsens after the injury should have healed. The mechanism is not fully understood but appears to involve sympathetic nervous system overactivation, central nervous system sensitization, inflammatory and autoimmune components, and microvascular dysfunction.
The result is severe pain combined with characteristic changes: pain disproportionate to the original injury; burning, electric, or stabbing pain; allodynia (pain from light touch); hyperalgesia; skin color changes; temperature differences between the affected and unaffected side; swelling; changes in sweating, hair, or nail growth; joint stiffness; and sometimes tremor or weakness. It typically affects an extremity and is classified as Type 1 (without confirmed nerve injury, the most common) or Type 2 (with confirmed nerve injury). CRPS is a clinical diagnosis, and imaging often looks normal, which is part of why it is so often missed.
## Why Earlier Treatment Matters
CRPS responds better to earlier intervention. Patients who receive specific CRPS treatment within the first months of symptom onset generally have better outcomes than those who go years without it, because as CRPS persists the central nervous system changes can become more entrenched. This is why we emphasize prompt evaluation; both physicians specialize in CRPS and can usually see suspected cases within the week.
That said, we do not want to discourage patients with longer-standing CRPS from pursuing treatment. Even patients with CRPS for years can experience meaningful improvement with appropriate intervention. We see all types of CRPS cases and help treat them. The treatments work; they just often work better with earlier application.
## How PHI Treats CRPS
The first step is comprehensive evaluation: a detailed history of your original injury and how symptoms developed, an examination assessing the characteristic features of CRPS, review of imaging and prior workup, and a discussion of what you have already tried and your goals.
Stellate ganglion block, for upper extremity CRPS, temporarily interrupts the sympathetic overactivation that maintains many CRPS symptoms; for appropriate responders the effect can outlast the local anesthetic, sometimes for weeks or months, and many patients receive a series of blocks for cumulative benefit. Lumbar sympathetic block applies the same mechanism for lower extremity CRPS. Both are performed under image guidance in our affiliated surgical center. Ketamine infusion therapy has substantial evidence specifically for CRPS, acting on the NMDA receptor to help reset the central nervous system sensitization; PHI administers physician-monitored ketamine in a clinic setting as an individualized course rather than a fixed protocol. Combined approaches are common, and we coordinate with pain-focused physical therapy and psychology, which play important roles in comprehensive CRPS care.
## When to See Someone
Consider professional evaluation when you have severe regional pain that has persisted beyond expected healing time, when the pain is disproportionate to your original injury, when you have skin color changes, temperature changes, or swelling in the affected area, when light touch produces pain, or when standard pain treatments have not helped. CRPS is one of the conditions where earlier evaluation matters; if you have symptoms suggesting CRPS, please call (310) 856-9488 to discuss an expedited consultation.
## Why PHI for CRPS Treatment
## Frequently Asked Questions
**Q: How is CRPS diagnosed?**
CRPS is a clinical diagnosis based on established criteria that require specific combinations of sensory, vasomotor, sudomotor, and motor or trophic findings. Imaging is typically used to rule out other conditions rather than to confirm CRPS itself. Many CRPS patients have normal-appearing imaging, which is part of why the condition is often missed.
**Q: Will I get better?**
Outcomes vary. Some patients experience dramatic improvement with appropriate treatment, particularly when treatment starts earlier. Others have more challenging cases. Even patients with longer-standing CRPS often experience meaningful improvement. The treatments work; they may produce different degrees of benefit for different patients.
**Q: How effective is stellate ganglion block for CRPS?**
For appropriate responders with upper extremity CRPS, stellate ganglion block often produces meaningful symptom reduction. The effect may outlast the local anesthetic itself, sometimes for weeks or months, and many patients receive a series of blocks for cumulative benefit.
**Q: How effective is ketamine for CRPS?**
Ketamine has substantial evidence specifically for CRPS, including studies showing meaningful pain reduction and functional improvement. For patients with severe or refractory CRPS, it is often a particularly important option. PHI administers physician-monitored ketamine in a clinic setting.
**Q: Can CRPS spread to other limbs?**
Yes, in some patients. CRPS that started in one extremity can sometimes develop in other limbs over time, which makes appropriate treatment of the original CRPS particularly important.
**Q: Is CRPS curable?**
Cure is not always the right word. Many patients experience significant symptom reduction with appropriate treatment, sometimes to the point of remission. Others experience meaningful improvement that significantly reduces but does not eliminate symptoms. We are honest about realistic expectations based on your specific situation.
**Q: What about physical therapy for CRPS?**
PT plays an important role, but it must be CRPS-specific PT delivered by therapists experienced with the condition, because standard PT approaches can sometimes worsen CRPS symptoms. We coordinate with appropriate PT providers when this is part of your plan.
**Q: Should I see a neurologist or a pain specialist?**
Both can play roles. Neurologists often help with diagnosis and medication management. Interventional pain specialists provide the specific procedural treatments, such as sympathetic blocks and ketamine, that have strong evidence for CRPS. Many patients benefit from coordinated care across both specialties.
**Q: Do you take insurance?**
Insurance coverage and payment options may vary. Please contact our office to discuss your specific plan, available options, and pricing. All pricing is disclosed at consultation.
**Q: Do you accept international patients?**
Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations.
## Treatments We Offer for CRPS
PHI offers evidence-based treatments specifically for Complex Regional Pain Syndrome, matched to whether your CRPS affects the upper or lower extremity and your treatment history.
- Stellate Ganglion Block, for upper extremity CRPS
- Lumbar Sympathetic Block, for lower extremity CRPS
- Ketamine Infusion Therapy, substantial evidence for CRPS
> Validation of proposed diagnostic criteria (the Budapest Criteria) for Complex Regional Pain Syndrome. Peer-reviewed via PubMed.
— [Harden NR, et al.](https://pubmed.ncbi.nlm.nih.gov/20493633/)
> Ketamine for Complex Regional Pain Syndrome: a narrative review highlighting dosing practices and treatment response. Peer-reviewed via PMC.
— [Lii TR, et al.](https://pmc.ncbi.nlm.nih.gov/articles/PMC10688501/)
## Schedule Your CRPS Consultation
A 60-minute consultation will evaluate your specific situation, apply established CRPS diagnostic criteria, and walk through the treatment options that match your particular case. Call (310) 856-9488 or book online now.
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