CRPS: More Than Just Pain By APA Physiotherapist Ben Howie

Understanding a complex and often misunderstood condition

Complex Regional Pain Syndrome (CRPS) is a chronic pain condition that can be confusing, overwhelming, and frustrating for those living with it. It’s often misunderstood - even by people experiencing it - because the pain and symptoms can seem out of proportion to what initially caused them.

This blog aims to explain what CRPS is, why it happens, and how physiotherapy can play a meaningful role in recovery and long-term management.

 

What Is CRPS?

CRPS is a chronic pain condition that most commonly affects a person’s arm or leg. It often develops after an injury, fracture, surgery, or trauma - but in some cases, it can occur without a clear trigger.

A key feature of CRPS is that the pain and symptoms are out of proportion to the original injury. That doesn’t mean the pain isn’t real - it means the nervous system is behaving differently.

CRPS can affect people of all ages and activity levels, and its presentation can vary significantly from person to person.

 

What Does CRPS Look Like?

CRPS doesn’t look the same for everyone, and symptoms can change over time. Features commonly include:

  • Severe, persistent pain

  • Increased sensitivity to touch, pressure, and/or temperature

  • Swelling in the affected limb

  • Changes in skin colour or temperature

  • Reduced movement, stiffness, or weakness

  • Changes in skin texture, hair growth, or nail growth

Some people experience flare-ups, while others notice gradual changes. This variability is one reason CRPS can be difficult to diagnose and manage - but it’s also why individualised care is so important.

 

Why Does CRPS Happen?

What’s going on in the body?

CRPS occurs when the nervous system becomes over-protective.

After an injury, pain is a normal and helpful warning signal. In CRPS, however, the nervous system continues to sound the alarm long after tissues have healed - or reacts far more strongly than expected.

This can involve:

  • Amplified pain signals

  • Changes in circulation and inflammation

  • Altered communication between the brain and the affected limb

Importantly, CRPS pain is real. It is not imagined, exaggerated, or “just in your head.” The pain reflects genuine changes in how the nervous system is processing information.

 

How Can Physiotherapy Help?

Physiotherapy plays a key role in the management of CRPS, particularly when treatment begins early and is approached gently and progressively.

Rather than pushing through pain, physiotherapy for CRPS focuses on helping the nervous system feel safe again.

This may include:

  • Gentle, graded movement to restore function and confidence

  • Desensitisation strategies to reduce sensitivity over time

  • Pain education to help you understand what’s happening and why

  • Pacing strategies to avoid flare-ups while maintaining activity

  • Functional goals that matter to you

Physiotherapists often work closely with GPs, pain specialists, psychologists, and other health professionals as part of a multidisciplinary approach, which has been shown to produce better outcomes in persistent pain conditions.

 

Living With CRPS

Recovery from CRPS looks different for everyone.

For some people, symptoms improve significantly over time. For others, progress may be slower and less predictable. What matters most is having the right support, realistic expectations, and a plan that adapts as you do.

Key things to remember:

  • Progress is often gradual, not linear

  • Education and understanding reduce fear and improve outcomes

  • Movement is important - but it must be safe and graded

  • You are not alone, and help is available

 

When Should You Seek Help?

If pain persists longer than expected after an injury or surgery - especially if it feels severe, unusual, or disproportionate - early assessment can make a meaningful difference.

Physiotherapy, combined with the right education and support, can help you regain function, confidence, and quality of life.

If you’re concerned about ongoing pain or changes in how your body feels, speaking with a physiotherapist early is a positive first step.

 

References

 

1.        Erfan Shafiee, MacDermid, JC, Packham, TL, Grewal, R, Farzad, M, Pavlos Bobos & Walton, DM 2023, ‘Rehabilitation Interventions for Complex Regional Pain Syndrome; An Overview of Systematic Reviews’, The Clinical Journal of Pain, vol. 39, Lippincott Williams & Wilkins, no. 9, pp. 473–483.

2.        Kanika, Goyal, M & Goyal, K 2023, ‘Effectiveness of the physiotherapy interventions on complex regional pain syndrome in patients with stroke: A systematic review and meta-analysis’, Journal of Bodywork and Movement Therapies, vol. 35, Elsevier BV, pp. 175–181.

3.        Ordoñez-Mora, LT, Quintero-López, DS, Morales-Osorio, MA, Gómez-Gómez, JF, Rivas-Tafurt, GP & Serna-Orozco, MF 2025, ‘Neurocognitive Interventions Informed by Cognitive–Behavioural Therapy (CBT) Principles and Physical Exercise for Complex Regional Pain Syndrome: A Systematic Review’, Journal of Clinical Medicine, vol. 14, MDPI AG, no. 19, p. 6820.

4.        Shafiee, E, MacDermid, J, Packham, T, Walton, D, Grewal, R & Farzad, M 2023, ‘The Effectiveness of Rehabilitation Interventions on Pain and Disability for Complex Regional Pain Syndrome’, The Clinical Journal of Pain, vol. 39, no. 2, pp. 91–105.

Stuart McKayComment