Complex Regional Pain Syndrome: Burning Pain After Injury

After a broken wrist, a sprained ankle, or even minor surgery, most people expect pain to fade over weeks. But for some, the pain doesn’t just stick around-it grows worse. It becomes a deep, unrelenting burning sensation, as if the skin is on fire from the inside. Even the lightest touch-a blanket, a breeze, or a sleeve brushing against the arm-can feel like a shock. This isn’t normal. This is Complex Regional Pain Syndrome (a chronic neurological condition that causes severe, disproportionate pain after an injury, often affecting an arm or leg), or CRPS.

CRPS doesn’t follow the rules of typical healing. You don’t need a major injury to trigger it. A simple fracture, a cut, a sprain, or even an injection can set it off. In fact, about 40% of cases start after a fracture, especially in the wrist. But here’s the twist: not everyone with a broken bone gets CRPS. Why some people do and others don’t remains one of the biggest mysteries in pain medicine.

What Does CRPS Actually Feel Like?

People with CRPS describe the pain in ways that sound extreme-even impossible. It’s not just soreness. It’s burning, stabbing, electric, or tearing. The pain doesn’t match the injury. A small cut leads to pain that feels like a third-degree burn. A sprained ankle causes pain that spreads up the leg, even if the ankle itself has healed.

It’s not just about pain. The body changes too. The skin over the affected area might become:

• Shiny, thin, or tight
• Red, purple, or blotchy
• Warmer or colder than the other side
• Swollen or sweaty

Some notice hair or nails growing faster-or suddenly stopping. Muscles twitch. Joints stiffen. Fine motor skills vanish. You might drop a glass because your fingers won’t cooperate. Tremors or spasms can make holding a cup impossible.

One of the most disturbing signs is allodynia-when something harmless, like a light touch, triggers intense pain. A doctor’s stethoscope, a breeze, or even a bedsheet can feel unbearable. This isn’t “being sensitive.” It’s your nervous system sending wrong signals, nonstop.

Why Does This Happen?

CRPS isn’t just “bad pain.” It’s a malfunction in your nervous system. Your body’s alarm system got stuck. Instead of turning off after the injury heals, it keeps screaming.

Three main things go wrong:

1. Inflammation: In the early stages, your body releases inflammatory chemicals around the injured nerves. This causes swelling, redness, and heat.
2. Nerve damage: In over 90% of cases, tiny nerve fibers-too small to see on an X-ray-get damaged. These fibers normally control pain signals and blood flow. When they’re injured, they misfire.
3. Sympathetic nervous system overdrive: This is the part of your nervous system that handles stress responses. In CRPS, it gets stuck in “fight or flight” mode, making pain worse and blood vessels react abnormally.

Some research suggests CRPS might even have an autoimmune component. A 2022 study found specific antibodies in 30% of CRPS patients-antibodies that attack the body’s own nerve tissue. This could explain why symptoms spread beyond the injury site.

It’s not just one thing. It’s a chain reaction: injury → nerve damage → inflammation → nervous system chaos → brain misinterprets signals → pain becomes chronic.

Who Gets CRPS?

It’s not random. Certain patterns show up:

• Women are three times more likely to develop CRPS than men. Why? Researchers aren’t sure, but hormones and immune response differences may play a role.
• Ages 40 to 60 are most affected, but it can happen to teens and older adults too.
• Timing matters. Symptoms usually appear 4 to 6 weeks after the injury. If pain spikes after a cast is applied or a bandage feels too tight, that’s a red flag.
• It’s rare. Only about 20 in every 100,000 people get it each year. But because it’s often misdiagnosed, the real number might be higher.

There’s no genetic test for CRPS. No blood marker. No scan that shows it. That’s why so many people are told it’s “in their head” or “just anxiety.” But it’s real-and it’s physical.

How Is It Diagnosed?

There’s no X-ray, MRI, or blood test that confirms CRPS. Diagnosis relies on the Budapest Criteria, set by the International Association for the Study of Pain. To meet the criteria, you need:

• Pain that’s ongoing and disproportionate to the injury
• At least one symptom in three of these four categories:
• Sensory (burning, tingling, allodynia)
• Vasomotor (temperature changes, skin color shifts)
• Sudomotor/edema (sweating, swelling)
• Motor/trophic (weakness, tremors, hair/nail changes)
• At least one sign (observable by a doctor) in two or more categories
• No other condition explains the symptoms

Early diagnosis is everything. If CRPS is caught within the first 3 months, treatment has a much better chance of stopping it before it becomes permanent.

Treatment: What Actually Works?

CRPS doesn’t heal on its own for everyone. Some people improve slowly. Others live with pain for years. But treatment can change the course.

Physical therapy is the cornerstone. Not rest. Not avoidance. Movement. Gentle, guided movement helps retrain the nervous system. A physical therapist will work with you to slowly restore range of motion, strength, and coordination-even if it hurts. Avoiding movement makes stiffness and muscle loss worse.

Medications help, but they’re not magic:

• NSAIDs (like ibuprofen) can help in early stages if inflammation is high.
• Corticosteroids (like prednisone) may reduce swelling and pain in the first few weeks.
• Neuropathic pain drugs like gabapentin or pregabalin target misfiring nerves.
• Antidepressants like amitriptyline can help with both pain and sleep.

Nerve blocks involve injecting numbing medicine near the affected nerves. For some, this breaks the pain cycle, even temporarily. If it works, it gives your nervous system a reset.

Spinal cord stimulation is a more advanced option. A small device is implanted near the spine. It sends mild electrical pulses that block pain signals before they reach the brain. Many patients report 50% or more pain reduction.

Ketamine infusions are being tested in clinical trials. Low-dose ketamine can quiet the overactive nervous system. It’s not standard yet, but early results are promising.

What Doesn’t Work

Many treatments fail because they target the wrong thing:

• Just taking painkillers won’t fix nerve misfiring.
• Staying inactive leads to muscle loss and joint stiffness, making CRPS worse.
• Ignoring the emotional toll doesn’t help. Stress and anxiety feed the pain cycle.

CRPS isn’t a mental health issue-but it absolutely affects mental health. Depression, anxiety, and insomnia are common. That’s why treatment should include psychological support, not as a substitute, but as part of the whole plan.

Can It Go Away?

Some people do recover fully-especially if treatment starts early. About half of patients see major improvement within 1 to 2 years. But for others, pain lingers. It can change in intensity, but it doesn’t vanish.

That doesn’t mean hope is gone. Even in chronic cases, pain can be managed. Function can be restored. Quality of life can improve. The goal isn’t always “cured.” It’s “controlled.”

What Should You Do If You Suspect CRPS?

If you had an injury and now:

• Have burning, shooting, or electric pain that’s worse than expected
• Notice skin changes-color, texture, temperature
• Feel extreme sensitivity to touch
• Notice swelling, stiffness, or weakness that doesn’t improve

Don’t wait. Go to a pain specialist or neurologist. Bring a list of your symptoms and when they started. Mention CRPS by name. Ask if the Budapest Criteria apply.

Early action is your best defense. Delaying treatment by even a few months can turn a treatable condition into a lifelong one.

If you’re living with this pain, you’re not alone. But you need to act fast. The window for stopping CRPS before it becomes permanent is narrow. Don’t wait for it to get worse. Get help now.