Complex Regional Pain Syndrome (CRPS).
What is complex regional pain syndrome?
Complex regional pain syndrome (CRPS) is a chronic pain condition characterised by severe, disproportionate and persistent pain in a limb — typically an arm or leg — that develops following injury, surgery, stroke or immobilisation. The pain is out of proportion to the severity of the original injury and persists or worsens beyond the expected healing time, accompanied by a constellation of sensory, autonomic and motor changes that distinguish CRPS from other chronic pain conditions.
CRPS was historically known by a variety of names — reflex sympathetic dystrophy (RSD), causalgia, Sudeck's atrophy, algodystrophy — before the International Association for the Study of Pain (IASP) standardised the terminology and diagnostic criteria.
Types of CRPS
Two types are recognised based on whether a specific nerve injury is identified.
CRPS Type I — the more common type, formerly called reflex sympathetic dystrophy — occurs following tissue injury, surgery or immobilisation without a clearly identified peripheral nerve lesion. It most commonly follows fractures, sprains or soft tissue injuries, and can also develop after stroke or myocardial infarction.
CRPS Type II — formerly called causalgia — is associated with a demonstrable nerve injury. The symptoms are similar to Type I but the underlying nerve lesion is identifiable.
In practice the distinction between the two types has less clinical significance than the Budapest criteria — the current diagnostic standard — which requires signs and symptoms across at least three of four categories: sensory, vasomotor, sudomotor/oedema, and motor/trophic.
What are the symptoms?
CRPS produces a characteristic cluster of symptoms that extends well beyond pain:
What causes CRPS?
The exact mechanism of CRPS is not fully understood, but it is believed to involve dysfunction in both the peripheral and central nervous systems — including peripheral sensitisation, central sensitisation, neuroinflammation, and in some cases sympathetically maintained pain. Psychological factors including anxiety, catastrophising and fear-avoidance are not causes of CRPS but significantly influence its severity and trajectory, and are important treatment targets alongside the physical interventions.
Early recognition and treatment significantly improve outcomes — CRPS that is identified and treated within the first year has a considerably better prognosis than longstanding established CRPS.
How can physiotherapy help?
Physiotherapy is a cornerstone of CRPS management and has a distinctive evidence base that differs significantly from standard musculoskeletal physiotherapy. The approach is built on understanding CRPS as a condition of nervous system sensitisation and cortical reorganisation — and targeting these mechanisms directly.
Graded Motor Imagery (GMI) is the most distinctive and evidence-based physiotherapy intervention for CRPS. GMI is a structured program that progressively engages the cortical motor networks without triggering pain — beginning with mental rotation tasks (judging whether photographs of limbs are left or right), progressing to explicitly imagining movements, and finally to mirror therapy. This graduated approach to cortical activation progressively reduces the central sensitisation and cortical reorganisation that maintain CRPS pain and movement dysfunction. The Graded Motor Imagery program, developed by Lorimer Moseley and colleagues in Australia, has the strongest evidence base of any single physiotherapy intervention for CRPS.
Mirror therapy — the final stage of GMI — involves the patient observing the reflection of their unaffected limb in a mirror, creating the visual illusion that the affected limb is moving normally. This visual feedback modulates cortical processing of the affected limb and can produce meaningful pain reduction, particularly in upper limb CRPS.
Desensitisation — gradually introducing different textures, temperatures and sensory stimuli to the hypersensitive affected area — progressively reduces the peripheral and central sensitisation that drives allodynia and hyperalgesia. The program begins with stimuli well below the pain threshold and systematically progresses toward normal sensory input.
Graded activity and functional restoration — progressively increasing use of the affected limb in functional activities using a quota-based (time and activity contingent rather than pain contingent) framework — reverses the disuse and learned non-use that compound CRPS disability. The counterintuitive principle is that resting and protecting the affected limb to avoid pain perpetuates and worsens CRPS — appropriate graded activity is therapeutic.
Oedema management — compression garments, hydrotherapy, gentle aerobic exercise and lymphatic techniques reduce the swelling that contributes to pain and stiffness in the affected limb.
Pain neuroscience education — helping patients understand the nervous system mechanisms underlying their pain — reduces fear-avoidance, catastrophising and the sense of helplessness that commonly accompany CRPS and significantly influence its severity. This is consistent with the broader chronic pain management approach we use at Articulate.
Joint and muscle maintenance — gentle range of motion exercises within pain tolerance, hydrotherapy and splinting prevent the contractures and muscle atrophy that develop from prolonged disuse in established CRPS.
Clinical Pilates can be carefully integrated in later stages of CRPS rehabilitation — the emphasis on body awareness, gentle movement and progressive loading in a supported environment makes it suitable when direct limb loading is appropriate. Real time ultrasound assists in retraining muscle activation where CRPS-related motor inhibition has disrupted normal neuromuscular patterns.
CRPS management is best delivered within a multidisciplinary framework — physiotherapy alongside pain medicine, psychology and occupational therapy produces better outcomes than any single discipline alone. We work collaboratively with referring pain specialists and GPs to ensure coordinated care.
For NDIS participants with CRPS, physiotherapy is claimable under therapeutic supports. See our NDIS physiotherapy page.
Our physiotherapists Yulia Khasyanova and Mauricio Bara both have experience in complex pain conditions and are members of the Australian Physiotherapy Association. Yulia's certification in the Biopsychosocial Reframed Chronic Pain Treatment Model and her specialist experience in complex neurological and pain conditions is particularly relevant for CRPS management.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
Complex regional pain syndrome (CRPS) is a chronic pain condition characterised by severe, disproportionate and persistent pain in a limb — typically an arm or leg — that develops following injury, surgery, stroke or immobilisation. The pain is out of proportion to the severity of the original injury and persists or worsens beyond the expected healing time, accompanied by a constellation of sensory, autonomic and motor changes that distinguish CRPS from other chronic pain conditions.
CRPS was historically known by a variety of names — reflex sympathetic dystrophy (RSD), causalgia, Sudeck's atrophy, algodystrophy — before the International Association for the Study of Pain (IASP) standardised the terminology and diagnostic criteria.
Types of CRPS
Two types are recognised based on whether a specific nerve injury is identified.
CRPS Type I — the more common type, formerly called reflex sympathetic dystrophy — occurs following tissue injury, surgery or immobilisation without a clearly identified peripheral nerve lesion. It most commonly follows fractures, sprains or soft tissue injuries, and can also develop after stroke or myocardial infarction.
CRPS Type II — formerly called causalgia — is associated with a demonstrable nerve injury. The symptoms are similar to Type I but the underlying nerve lesion is identifiable.
In practice the distinction between the two types has less clinical significance than the Budapest criteria — the current diagnostic standard — which requires signs and symptoms across at least three of four categories: sensory, vasomotor, sudomotor/oedema, and motor/trophic.
What are the symptoms?
CRPS produces a characteristic cluster of symptoms that extends well beyond pain:
- Pain — continuous, severe, burning pain in the affected limb that is disproportionate to any ongoing tissue injury and is often triggered or worsened by light touch (allodynia), temperature changes or movement. The pain may spontaneously spread beyond the original injury site.
- Sensory changes — hyperalgesia (increased sensitivity to painful stimuli), allodynia (pain from normally non-painful stimuli such as light touch or clothing), and altered temperature sensation.
- Vasomotor changes — changes in skin temperature (the affected limb may be warmer or cooler than the opposite side) and skin colour changes (red, purple, mottled or pale).
- Sudomotor changes and oedema — abnormal sweating and swelling of the affected limb.
- Motor and trophic changes — weakness, tremor, dystonia (abnormal postures), and changes in hair and nail growth. In established CRPS, contractures and significant functional limitation can develop.
What causes CRPS?
The exact mechanism of CRPS is not fully understood, but it is believed to involve dysfunction in both the peripheral and central nervous systems — including peripheral sensitisation, central sensitisation, neuroinflammation, and in some cases sympathetically maintained pain. Psychological factors including anxiety, catastrophising and fear-avoidance are not causes of CRPS but significantly influence its severity and trajectory, and are important treatment targets alongside the physical interventions.
Early recognition and treatment significantly improve outcomes — CRPS that is identified and treated within the first year has a considerably better prognosis than longstanding established CRPS.
How can physiotherapy help?
Physiotherapy is a cornerstone of CRPS management and has a distinctive evidence base that differs significantly from standard musculoskeletal physiotherapy. The approach is built on understanding CRPS as a condition of nervous system sensitisation and cortical reorganisation — and targeting these mechanisms directly.
Graded Motor Imagery (GMI) is the most distinctive and evidence-based physiotherapy intervention for CRPS. GMI is a structured program that progressively engages the cortical motor networks without triggering pain — beginning with mental rotation tasks (judging whether photographs of limbs are left or right), progressing to explicitly imagining movements, and finally to mirror therapy. This graduated approach to cortical activation progressively reduces the central sensitisation and cortical reorganisation that maintain CRPS pain and movement dysfunction. The Graded Motor Imagery program, developed by Lorimer Moseley and colleagues in Australia, has the strongest evidence base of any single physiotherapy intervention for CRPS.
Mirror therapy — the final stage of GMI — involves the patient observing the reflection of their unaffected limb in a mirror, creating the visual illusion that the affected limb is moving normally. This visual feedback modulates cortical processing of the affected limb and can produce meaningful pain reduction, particularly in upper limb CRPS.
Desensitisation — gradually introducing different textures, temperatures and sensory stimuli to the hypersensitive affected area — progressively reduces the peripheral and central sensitisation that drives allodynia and hyperalgesia. The program begins with stimuli well below the pain threshold and systematically progresses toward normal sensory input.
Graded activity and functional restoration — progressively increasing use of the affected limb in functional activities using a quota-based (time and activity contingent rather than pain contingent) framework — reverses the disuse and learned non-use that compound CRPS disability. The counterintuitive principle is that resting and protecting the affected limb to avoid pain perpetuates and worsens CRPS — appropriate graded activity is therapeutic.
Oedema management — compression garments, hydrotherapy, gentle aerobic exercise and lymphatic techniques reduce the swelling that contributes to pain and stiffness in the affected limb.
Pain neuroscience education — helping patients understand the nervous system mechanisms underlying their pain — reduces fear-avoidance, catastrophising and the sense of helplessness that commonly accompany CRPS and significantly influence its severity. This is consistent with the broader chronic pain management approach we use at Articulate.
Joint and muscle maintenance — gentle range of motion exercises within pain tolerance, hydrotherapy and splinting prevent the contractures and muscle atrophy that develop from prolonged disuse in established CRPS.
Clinical Pilates can be carefully integrated in later stages of CRPS rehabilitation — the emphasis on body awareness, gentle movement and progressive loading in a supported environment makes it suitable when direct limb loading is appropriate. Real time ultrasound assists in retraining muscle activation where CRPS-related motor inhibition has disrupted normal neuromuscular patterns.
CRPS management is best delivered within a multidisciplinary framework — physiotherapy alongside pain medicine, psychology and occupational therapy produces better outcomes than any single discipline alone. We work collaboratively with referring pain specialists and GPs to ensure coordinated care.
For NDIS participants with CRPS, physiotherapy is claimable under therapeutic supports. See our NDIS physiotherapy page.
Our physiotherapists Yulia Khasyanova and Mauricio Bara both have experience in complex pain conditions and are members of the Australian Physiotherapy Association. Yulia's certification in the Biopsychosocial Reframed Chronic Pain Treatment Model and her specialist experience in complex neurological and pain conditions is particularly relevant for CRPS management.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
