Complex Regional Pain Syndrome (CRPS) is a chronic pain condition, typically following limb injury, characterised by disproportionate pain, swelling, temperature and colour changes, and functional impairment. Two subtypes exist: CRPS-I (without confirmed nerve injury) and CRPS-II (with documented nerve injury). Early recognition and multimodal treatment optimise outcomes.
Diagnosis is clinical, based on International Association for the Study of Pain (IASP) criteria: proportionate or disproportionate pain, and signs of inflammation (swelling, colour/temperature changes) plus sensory, motor, or sudomotor abnormalities. Early treatment is critical; delay worsens prognosis. Physiotherapy and occupational therapy emphasising graded motor imagery, desensitisation, and gradual functional mobilisation are first-line. Pharmacotherapy includes neuropathic pain agents (gabapentin, pregabalin, duloxetine), topical agents (EMLA cream, capsaicin), and in severe cases, systemic corticosteroids in early CRPS-I. Intravenous bisphosphonates (pamidronate, alendronate) show efficacy in reducing pain and improving bone metabolism. Psychological support addresses pain catastrophising and mood disturbance. Interventional approaches include sympathetic nerve blocks and spinal cord stimulation for severe refractory pain.
Acupuncture is explored for pain management with variable outcomes; some trials report symptom relief. Traditional herbal remedies and anti-inflammatory supplements (curcumin, omega-3 fatty acids) are practised. Mirror therapy, in which patients observe their unaffected limb in a mirror whilst the affected limb is hidden, shows promise for pain reduction and motor recovery in some CRPS populations. Mindfulness-based stress reduction and psychological therapies address emotional sequelae.
Stem cell therapy is studied for CRPS, targeting neuroinflammation and restoration of local tissue homeostasis. Bone marrow-derived stem cells and adipose tissue stem cells are investigated in early-stage research; proposed mechanisms include immunomodulation and reduction of pro-inflammatory cytokines. Current clinical applications remain experimental with limited published data. Outcomes are not yet predictable or standardised. Candidate assessment focuses on severe, refractory CRPS unsuitable for conventional interventions.
| Option | Type | Evidence | Indicative cost | Invasiveness | Recovery |
|---|---|---|---|---|---|
| IASP diagnostic criteria assessment | Standard | Strong | €300–€600 | Low | Immediate |
| Physiotherapy & graded motor imagery | Standard | Strong | €80–€180 per session | Low | Ongoing |
| Neuropathic pain pharmacotherapy | Standard | Strong | €40–€120/month | Low | 2–4 weeks |
| Intravenous bisphosphonates | Standard | Strong | €1,500–€3,000 per infusion | Medium | 1–2 weeks |
| Mirror therapy | Alternative | Moderate | €50–€150/month | Low | Ongoing |
| Acupuncture | Alternative | Moderate | €70–€140 per session | Low | Immediate |
| Spinal cord stimulation | Standard | Moderate | €15,000–€30,000 | High | 4–6 weeks |
| Stem cell immunomodulatory therapy | Regenerative | Investigational | €18,000–€35,000 | Medium | 4–6 weeks |
Early intervention, within weeks to a few months of onset, significantly improves outcomes and reduces chronicity. Delayed diagnosis allows pathological neuroinflammation and maladaptive plasticity to establish, making recovery substantially more difficult. Prompt recognition by healthcare providers is essential.
Graded motor imagery involves three stages: laterality recognition (identifying whether a limb image is left or right), implicit motor imagery (mentally performing movements without actual movement), and explicit motor imagery (imagining detailed movements). Progressive stages, combined with mirror therapy, help recalibrate the brain's representation of the affected limb, reducing pain and improving function.
Spinal cord stimulation delivers electrical pulses near the spinal cord to modulate pain signals. It is reserved for severe, refractory pain unsuitable for other interventions. Efficacy varies; approximately 50–60% of patients achieve meaningful pain reduction. Trialling precedes permanent implantation.
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Educational overview of treatment options; not medical advice. Standard treatments reflect mainstream guidance; regenerative/stem-cell uses are largely investigational. Reviewed by the StemCellAtlas editorial team.
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