Complex Regional Pain Syndrome — Timoteo Almeida, MD, PhD

Complex Regional Pain Syndrome

A chronic pain condition with pain disproportionate to the original injury, often accompanied by color changes, swelling, and temperature differences. When standard treatments aren't enough, neuromodulation can be part of a broader plan.

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Disproportionate regional pain

Pain far exceeding the original injury, with sensory and autonomic changes — temperature shifts, color changes, swelling, sweating differences.

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Careful diagnosis matters

Diagnosis uses the Budapest criteria after ruling out other causes. Accurate diagnosis is essential before planning treatment.

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Neuromodulation for refractory cases

For carefully selected patients, spinal cord or DRG stimulation can be part of a multidisciplinary treatment plan.

Understanding your condition

What is CRPS?

CRPS most often develops after trauma or surgery to an arm or leg. It may involve burning pain, sensitivity to touch, color and temperature differences between limbs, swelling, and movement limitations. The pain is characteristically disproportionate to the triggering event.

Because CRPS can overlap with other disorders, careful diagnosis and a coordinated treatment plan — combining rehabilitation, medications, and interventional options — are important. No single treatment works for everyone, and most patients benefit from a multidisciplinary approach.

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Burning pain

Intense, often continuous pain disproportionate to injury

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Temperature changes

Affected limb feels hotter or colder than the other side

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Color differences

Skin may appear red, blue, purple, or blotchy

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Swelling & sweating

Edema and altered sweating patterns in the affected area

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Budapest Criteria

CRPS is typically diagnosed using the Budapest criteria — a standardized clinical framework that evaluates pain, sensory, vasomotor, sudomotor/edema, and motor/trophic signs — after ruling out other conditions that could explain the symptoms.

Am I a candidate?

Who may benefit from neuromodulation?

You may be a candidate if:

Neuromodulation is considered after standard treatments have been given a thorough trial.

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CRPS has been diagnosed using accepted criteria and persists despite appropriate rehabilitation and medical management.
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Pain is chronic and function-limiting, and you can participate in device trialing and follow-up.

Your options

Treatment Options

Two neuromodulation approaches are available for CRPS. The best choice depends on your pain pattern, location, and clinical evaluation.

⚙ Spinal cord

Spinal Cord Stimulation (SCS)

Epidural neuromodulation of pain pathways

How it works Leads placed in the epidural space deliver electrical pulses that modulate pain signaling pathways at the spinal cord level. A small generator is implanted under the skin.

Trial first Temporary leads are placed for several days so you can evaluate pain relief and function before committing to a permanent implant.

Best suited for Broader pain distributions across a limb or involving multiple dermatomes.

Adjustable Reversible Trial first Programmable

🎯 Targeted nerve root

DRG Stimulation

Dorsal root ganglion neuromodulation

How it works Leads are placed near the dorsal root ganglion — the nerve structure where sensory signals enter the spinal cord — allowing more targeted stimulation of specific pain areas.

Evidence Randomized comparative research has shown strong results for CRPS, particularly versus traditional SCS, though availability varies by center.

Best suited for Focal lower-extremity CRPS pain — especially when the pain is concentrated in a specific area like the foot or knee.

Targeted Focal pain Lower extremity Trial first

Your journey

What to Expect

Both SCS and DRG stimulation follow a "try before you commit" pathway — you experience the therapy before making a permanent decision.

Evaluation

Confirm CRPS diagnosis, assess functional goals, evaluate mental health and support systems (standard for neuromodulation), and plan a trial approach.

Trial Period

Short outpatient procedure with temporary leads. You track pain and function changes, as well as activity tolerance, during your normal daily routine.

Permanent Implant

If the trial is successful, leads and generator are permanently implanted. Several weeks of movement precautions followed by ongoing programming adjustments.

Weighing your decision

Benefits and Risks

Potential Benefits

✦ Improved pain control and daily function
✦ Results may vary and can change over time — reprogramming helps maintain benefit
✦ Reversible — can be turned off or removed
✦ DRG stimulation may offer more targeted relief for focal CRPS

Possible Risks

△ Common: Soreness, temporary stimulation sensations, need for repeated programming visits
△ Uncommon: Infection, bleeding, neurologic injury
△ Device-related: Lead migration or hardware failure — may require revision

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Recovery and follow-up

Most centers recommend limited bending, twisting, and lifting early after implant to reduce lead movement. Follow-up includes incision checks and multiple programming visits to optimize your settings over time.

Common questions

Patient FAQs

Does SCS "cure" CRPS?

No — SCS is a symptom-management tool designed to support your function and quality of life. It works best as part of a broader, multidisciplinary treatment plan that includes rehabilitation and other therapies.

How fast will I know if it works?

The trial period is designed to answer that question for you personally. Over several days with temporary leads, you'll track how your pain and function change during your normal daily routine.

What if my pain area changes?

Programming can often be adjusted to follow changes in your pain pattern. In some cases, additional strategies beyond reprogramming may be needed — your team will work with you to adapt the plan.

When to Seek Urgent Care

Seek urgent help for fever with incision redness or drainage, new weakness or numbness, severe headache, or loss of bowel or bladder control.