Complex regional pain syndrome can cause severe, persistent pain with swelling, sensitivity, color or temperature changes, and movement difficulty.
This video explains how CRPS may affect pain sensitivity, autonomic changes, movement, function, rehabilitation, and coordinated care.
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Hi, I’m Dr. Jason Seifferman, medical director at Manhattan Pain Medicine. Complex regional pain syndrome is one of the more complicated diagnoses we see and treat. CRPS generally starts after an injury. It may be a surgery, a fracture, sprain, other trauma. Rather than healing and normalizing, the nervous system becomes sensitized.
This often happens when that pain signal persists despite what should be normal healing. As the pain becomes more severe and longer-lasting, patients notice that the pain begins to feel out of proportion to the original injury. There may be swelling, sensitivity, changes in skin temperature, stiffness, weakness of associated joints, and in general difficulty using that limb. CRPS can also occur in the trunk and the pelvis, which we see frequently with pelvic pain.
A key point is that this is not just a tissue problem. CRPS involves abnormal pain processing in the peripheral and central nervous system. This is one of the reasons why it doesn’t improve when it’s treated like a routine injury alone. At Manhattan Pain Medicine, we take a diagnosis-first approach. We work to understand which parts of the nervous system are involved, what may be maintaining the pain, and how do we build a stepwise plan that improves comfort and restores function.
Treatment may include targeted nerve blocks, medication, movement-based rehabilitation or physical therapy, and in selected cases, neuromodulation. The earlier we see and treat CRPS, the better the improvement. Ultimately, we have to treat and silence the source of the ongoing pain, which I often refer to as a gas leak. And then we can calm down the flames and put the fire out.
Complex regional pain syndrome, or CRPS, is a chronic pain condition that most often affects one limb after an injury, surgery, stroke, heart attack, or other trigger. Pain may feel burning, severe, hypersensitive, or out of proportion to the original event. Symptoms can also include swelling, color or temperature changes, sweating changes, stiffness, weakness, tremor, skin sensitivity, and difficulty moving the affected area.
CRPS is complex because it may involve the nervous system, autonomic changes, inflammation, movement limitation, emotional distress, and central pain processing.
Early evaluation and coordinated treatment are important because function can decline when pain, fear of movement, and tissue sensitivity reinforce each other.
At Manhattan Pain Medicine, evaluation begins by confirming whether symptoms fit CRPS and whether other conditions may be contributing.
For patients looking for CRPS treatment in Manhattan, MPM evaluates pain quality, sensitivity, swelling, color or temperature changes, movement limitations, autonomic signs, prior injury or surgery, imaging, medication history, and functional impact.
Care may include medication management, physical rehabilitation coordination, pain psychology, biofeedback, sympathetic blocks, stellate ganglion blocks, lumbar sympathetic blocks, lidocaine and ketamine infusions, ketamine therapy, and ultrasound-guided procedures when clinically appropriate. The goal is a coordinated, stepwise plan that supports pain control and function without relying on one treatment alone.
CRPS can become harder to manage when pain leads to guarding, reduced movement, fear of touch, sleep disruption, swelling, stiffness, and functional decline. Patients may avoid using the affected limb because movement hurts, but prolonged avoidance can worsen sensitivity, weakness, and loss of range of motion. This is why early recognition and coordinated care matter.
A diagnosis-first evaluation is important because CRPS symptoms can resemble infection, blood clot, vascular disease, neuropathy, orthopedic injury, inflammatory disease, compartment syndrome, or other neurologic conditions. MPM evaluates the full pattern before recommending treatment.
When CRPS is likely, care often works best when medical pain management, rehabilitation, nervous system regulation, psychological support, and selected interventional options are aligned around the same functional goals.
CRPS fits across several MPM Zones of Expertise, including Complex Chronic Pain, Autonomic Dysfunction, Psychology of Pain, Musculoskeletal issues, and Pelvic Pain when regional or pelvic pain patterns overlap. This matters because CRPS can involve more than pain intensity. Patients may experience temperature changes, swelling, hypersensitivity, motor changes, tissue sensitivity, emotional distress, and functional loss.
MPM uses the Zones of Expertise framework to evaluate whether symptoms appear neuropathic, autonomic, musculoskeletal, centralized, sympathetically mediated, or psychologically reinforced through fear, trauma, sleep loss, and stress physiology. This supports a care plan that addresses the full pain system while still taking the physical biology of CRPS seriously.
I cannot say enough good things about Manhattan Pain Medicine. From the moment I walked in, I felt truly cared for and taken seriously. Dr. Nino Mikaberidze, Director of Rheumatology, is exceptional — knowledgeable, compassionate, and incredibly thorough. She takes the time to listen, explains every...
The best care I've received as a chronic pain patient. I traveled from out of state to visit Manhattan Pain Medicine because I could not find knowledgeable doctors in my hometown for my hypermobility, and Ehlers-Danlos syndrome symptoms and comorbidities. Let me tell you, it was worth every travel e...
I was injured in a bicycle accident over 8 years ago. I’ve suffered throughout the years since my accident with nothing seeming to work. PT, Yoga, lifestyle changes, NOTHNG! I finally made an appointment with Dr Kane and I’m feeling an improvement in my life. I no longer stay up all night in pain, a...
One of the best experiences, if not the best, I have ever had at the doctor’s office. From the front desk to the nurses to the PA assisting the doctor this was a great experience. Dr.Nino actually listened to me and came up with a game plan. Would recommend this practice to as many people as I could...
I have very unique & severe nerve pain from CRPS which has no known specific cure. Dr. Siefferman has a huge tool box, far greater than the other 23 Drs. I have seen. He saved me from jumping off a bridge and continues to help me with both treatments and advice. Dr. S. is in a different league!
After two years of searching and feeling lost and let down, I finally found real help at Manhattan Pain Medicine. With Dr. Siefferman, Adam Rosenberg, Dr. Mikaberidze, and the whole team, I feel heard, supported and understood. Every symptom is being considered and I’m finally getting answers with m...
Why is Dr Dr. Tayyaba Ahmed one of the top pevic Floor specialists - 1- She wants to know a full history of what led the patient to get to this point. 2 - She listens intensley to the patient 3- She does not rush you 4- Extremely skilled at giving pelvic floor injections 5- I thank my luck stars she...
The staff was friendly and helpful. Dr. Siefferman was thoughtful, listened, asked questions and proposed simple safe ways to come to further conclusions regarding my pain and discomfort. The office staff including Dr. Siefferman is responsive even after the initial in-person visit. Very pleased.
Dr. Siefferman is a brilliant provider. While my pain is still a work in progress, Dr Siefferman always gives me options and explains his reasoning behind things. He listens to my feedback and concerns. I never feel rushed; and am grateful he works to meet me where I am. I highly recommend him.
What a great find! They listen to me, I listen to them and the diagnosis is made and a plan developed to develop an approach to treat all of my chronic pain. I wish I could have discovered this type of treatment sooner. This doctor and group give me hope.
CRPS stands for complex regional pain syndrome. It is a chronic pain condition that often affects an arm, leg, hand, or foot after an injury, surgery, stroke, heart attack, or another trigger. The pain may feel severe or out of proportion to the original event. CRPS can involve the nervous system, autonomic changes, movement limitation, swelling, skin sensitivity, temperature changes, color changes, and functional decline. It is a real and biologically complex condition, but it should be diagnosed carefully because several other medical problems can mimic CRPS.
Common CRPS symptoms may include burning pain, severe sensitivity to touch, swelling, color changes, temperature changes, sweating changes, stiffness, weakness, tremor, reduced movement, changes in skin texture, and changes in hair or nail growth. The affected area may feel hot, cold, swollen, tight, painful, or difficult to use. Some patients cannot tolerate clothing, touch, movement, or weight-bearing. Symptoms may change over time and can affect sleep, mood, activity, and independence. Persistent or worsening symptoms after injury or surgery should be evaluated by a qualified clinician.
CRPS may develop after injury, surgery, stroke, heart attack, fracture, sprain, immobilization, or another physical trigger. In some cases, the original injury may seem minor compared with the severity of ongoing pain. The exact mechanism is not fully understood, but CRPS may involve abnormal pain signaling, autonomic nervous system changes, inflammation, nerve sensitization, blood flow changes, and altered movement patterns. It is not simply nerve damage, although nerve injury can be part of the picture in some patients. CRPS type 1 occurs without confirmed major nerve injury, while CRPS type 2 occurs with known nerve injury.
CRPS is diagnosed clinically, based on the symptom pattern, physical examination, and exclusion of other causes. A clinician may evaluate pain severity, sensitivity, swelling, color or temperature differences, sweating changes, motor function, range of motion, and skin or tissue changes. Testing may help rule out other conditions, but no single test confirms CRPS by itself. Conditions such as infection, blood clot, vascular disease, neuropathy, orthopedic injury, inflammatory disease, and compartment syndrome may need to be considered. A diagnosis-first evaluation helps ensure treatment is appropriate and safe.
Early treatment is important because CRPS can affect movement, sensitivity, strength, range of motion, sleep, and daily function. When pain leads to guarding or avoidance, the affected area may become more sensitive and harder to use. Earlier coordinated care may improve the chance of symptom control and functional recovery. Treatment often includes physical or occupational therapy, desensitization, medication management, pain psychology, biofeedback, and selected procedures when appropriate. Early treatment does not guarantee a specific outcome, but delayed recognition can make care more difficult.
CRPS treatment is usually multimodal. Options may include physical rehabilitation, desensitization, medication management, topical therapies, pain psychology, biofeedback, ultrasound-guided procedures, sympathetic blocks, stellate ganglion blocks, lumbar sympathetic blocks, lidocaine and ketamine infusions, ketamine therapy, and selected advanced interventional options when appropriate. Treatment depends on the affected region, symptom pattern, functional impact, risks, and prior response. Rehabilitation is often central to care, but it must be paced thoughtfully because movement can be painful. No single treatment works for every patient.
A sympathetic block is an injection that targets part of the sympathetic nervous system, which can contribute to some pain and autonomic symptoms. For upper extremity CRPS, a stellate ganglion block may be considered. For lower extremity CRPS, a lumbar sympathetic block may be considered. These blocks may help evaluate or reduce sympathetically mediated pain in selected patients. A response to a block can provide useful information, but it does not guarantee long-term relief or predict every treatment outcome. Sympathetic blocks should be considered as part of a broader treatment plan.
Yes. Pain psychology can help patients with CRPS manage fear of movement, stress, sleep disruption, trauma response, pacing, coping, and the emotional burden of severe persistent pain. This does not mean CRPS is imagined or “just psychological.” CRPS is a real pain condition that affects the nervous system and body. Pain psychology supports the brain and nervous system while medical and rehabilitative care continue. It can also help patients rebuild confidence, communicate symptoms clearly, and stay engaged with function-focused care.
Before care begins, our team helps patients understand the practical side of treatment, including insurance verification, out-of-network benefits, cost-share estimates, self-pay options, and billing questions. We believe patients should have as much clarity as possible before moving forward.
Complex regional pain syndrome, or CRPS, is a chronic pain condition that most often affects an arm, leg, hand, or foot. It may develop after an injury, surgery, stroke, heart attack, fracture, sprain, immobilization, or another trigger. In many cases, the pain feels more severe or longer-lasting than expected based on the original event. Patients may describe burning, electric, stabbing, crushing, deep aching, or extreme sensitivity to touch.
CRPS is not simply “nerve pain” or “pain after injury.” It is a complex condition that can involve the nervous system, autonomic regulation, inflammation, blood flow, movement patterns, tissue sensitivity, and central pain processing. It can also create emotional distress because patients may lose function quickly, fear movement, and feel misunderstood.
CRPS symptoms vary, but common features include severe regional pain, hypersensitivity, swelling, skin color changes, skin temperature differences, sweating changes, stiffness, weakness, tremor, reduced range of motion, and difficulty using the affected limb. Some patients notice changes in nail or hair growth, skin texture, or tissue sensitivity. The affected area may feel hot or cold compared with the other side.
Pain may worsen with touch, movement, temperature changes, stress, or activity. A light brush of clothing, a bedsheet, or gentle pressure may feel painful. Some patients avoid using the limb because movement hurts. This is understandable, but prolonged avoidance can contribute to stiffness, weakness, increased sensitivity, and functional decline.
The exact cause of CRPS is not fully understood. It may involve abnormal pain signaling, nerve sensitization, autonomic dysfunction, inflammation, and altered communication between the affected region and the central nervous system. CRPS type 1 occurs without confirmed major nerve injury. CRPS type 2 occurs when there is a known nerve injury.
CRPS may follow an injury or surgery, but the severity of pain can seem out of proportion to the original tissue injury. This does not mean the pain is exaggerated or imagined. It means the pain system may have become sensitized and dysregulated. The body’s protective systems may remain highly activated even after the initial injury should be healing.
A diagnosis-first approach is important because several conditions can resemble CRPS. These may include infection, blood clot, vascular disease, peripheral neuropathy, orthopedic injury, fracture, tendon injury, inflammatory arthritis, compartment syndrome, radiculopathy, central pain syndromes, or other neurologic conditions. Pelvic pain or regional trunk pain may also have overlapping autonomic, neuropathic, musculoskeletal, or centralized features.
MPM evaluates the full clinical pattern rather than relying on one symptom alone. Pain severity, sensitivity, swelling, color change, temperature change, motor function, prior injury, imaging, neurologic findings, and medical history all matter. Testing may support evaluation or rule out mimics, but CRPS remains a clinical diagnosis.
CRPS is often more responsive when recognized and treated early. Early care can help reduce guarding, support movement, address swelling and sensitivity, and prevent avoidable functional decline. Rehabilitation and physical therapy are often central to CRPS care, but therapy must be paced carefully. Pushing too aggressively can flare symptoms, while avoiding movement entirely can worsen loss of function.
A coordinated plan may include desensitization, graded movement, occupational therapy, physical therapy, medication management, pain psychology, biofeedback, sympathetic blocks, and selected infusion therapies when clinically appropriate. The plan should be adjusted based on response, tolerance, function, and goals.
CRPS treatment is multimodal. Medication management may include treatments for neuropathic pain, inflammation, sleep, muscle spasm, mood-related pain burden, or other symptom contributors when appropriate. Topical therapies may be useful for some patients. Pain psychology can help with fear of movement, sleep disruption, trauma response, pacing, symptom flares, and coping. Biofeedback may support nervous system regulation and body awareness.
Sympathetic blocks may be considered when symptoms suggest sympathetically mediated pain. Stellate ganglion blocks may be used for selected upper extremity or head and neck-related sympathetic pain patterns. Lumbar sympathetic blocks may be considered for selected lower extremity CRPS. Superior hypogastric plexus block may be considered for selected pelvic pain patterns, not as a general CRPS treatment.
Infusion therapy may be considered for selected severe or refractory neuropathic or centralized pain patterns. Lidocaine and ketamine infusions and ketamine therapy require careful patient selection, monitoring, and discussion of risks, goals, and expected outcomes. These treatments are not cures and should not be framed as guaranteed solutions.
CRPS can be physically intense and emotionally exhausting. Patients may fear touch, movement, flare-ups, medical visits, or loss of independence. They may also feel frustrated if others cannot see the severity of the pain. Pain psychology is not used because the pain is psychological. It is used because CRPS affects the nervous system, behavior, sleep, stress response, and daily function.
Pain psychology can help patients develop strategies for pacing, flare management, relaxation, communication, fear of movement, trauma response, and returning to meaningful activity. Biofeedback can also help some patients learn how stress physiology, muscle tension, breathing, and autonomic activation relate to symptoms.
Patients should seek urgent evaluation for rapidly worsening swelling, fever, spreading redness, new weakness, loss of pulses, severe color change, chest pain, shortness of breath, new neurologic deficits, or sudden severe pain after injury or surgery. These symptoms may reflect conditions other than CRPS, including infection, blood clot, vascular compromise, neurologic injury, or another urgent problem.
MPM approaches CRPS through a diagnosis-first, coordinated model. The evaluation looks at the pain pattern, autonomic changes, sensitivity, movement, function, emotional burden, prior injury or surgery, neurologic symptoms, and possible mimics. Care may involve medication management, rehabilitation coordination, pain psychology, biofeedback, ultrasound-guided injections, sympathetic blocks, stellate ganglion blocks, lumbar sympathetic blocks, lidocaine and ketamine infusions, ketamine therapy, and other selected interventions when appropriate.
For patients looking for CRPS treatment in Manhattan, MPM offers a careful, patient-centered approach to complex regional pain syndrome and related central pain syndromes. The goal is to confirm the clinical pattern, address pain and function together, and build a coordinated plan that respects the biological complexity and lived impact of CRPS.
