Complex Regional Pain Syndrome (CRPS)

Written by Sahar Swidan, PharmD, RPh, ABAAHP, FAARFM

Complex Regional Pain Syndrome (CRPS), also known as Reflex Sympathetic Dystrophy (RSD), is chronic pain in the nerves, arms or legs, back, foot, hands or joints developing after trauma, infection, surgery, stroke, heart attack and even pregnancy.

The pain is greater than would be expected from the injury that caused it, and the pain can last for years or even be lifelong.

Signs & Symptoms 

People with CRPS may experience a sensation of pins and needles, heightened sensitivity to pain or uncomfortable tingling and burning. Other symptoms include bone loss, nervous system dysfunction, sweating, muscle twitch, loss of muscle, muscle spasms, contractions and skin and vascular changes. Depression, headache, joint stiffness, redness, stiffness, swelling, tenderness, or tremor are also common.

Underlying Causes

On the more technical side, a recent review article demonstrated that there are several underlying causes of CRPS including cytokine release, microglia activation, central sensitization and autonomic nervous system dysfunction. Microglia cells are immune and structural cells that attach to nerve and brain cells and alter cellular activity and spinal sensory neuron excitability.

In the November 2015 issue of the LDN Research Trust newsletter, Dr. Leonard Weinstock wrote an interesting article on CRPS, where he theorized that cytokine production produced by small-intestinal bacterial overgrowth (SIBO) and obstructive sleep apnea act as stimuli for ongoing CRPS symptoms.


Treatment for CRPS usually consists of oral and topical medications, heat or cold therapy, physical therapy, and biofeedback.

Topical medications are often preferred to oral because side effects—such as sedation with oral gabapentin—are reduced when the medication is applied to the affected area topically. Low dose naltrexone (LDN) has been administered to attenuate microglia activation and regulate systemic inflammation, which is commonly found in patients with CRPS.

Dr. Swidan’s original blog post can be found here.

About Dr. Sahar Swidan

Dr. Swidan obtained her Doctor of Pharmacy degree from the University of Michigan and completed a 3-year research fellowship in Bio-Pharmaceutics at the University of Michigan. Previously, she was the Director of Pharmacy at the Chelsea Community Hospital and the clinical pharmacist for the inpatient head and chronic pain service. Currently, she is the President and CEO of Pharmacy Solutions in Ann Arbor, MI, which is a unique, personal and educational specialty pharmacy.

She is also the Clinical Associate Professor of Pharmacy at the University of Michigan, College of Pharmacy, and is a board certified and advanced fellow in anti-aging and regenerative medicine. She is an internationally known speaker in the areas of pain management and BHRT, and has authored several books, articles and patient education material in the area of pain management and functional medicine. Currently, Dr. Swidan is completing a Master’s program in Cardio-Metabolic and Functional Medicine.


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