Manual Therapy

Why does complex regional pain syndrome (CRPS) spread?

After evaluating a patient today who presented to my clinic with CRPS in his foot, which was spreading to his contra-lateral foot, I went to the literature to assess why CRPS spreads.
After a quick search on Google Scholar, I was pleased to find an article published in the Journal of Neural Transmission (honestly the first time I ever heard of this journal) on the spreading on CRPS. In summary, this article has the following conclusions about the spontaneous spreading of CRPS which I found interesting…:

1. Out of 185 subjects studied over a 6 year period, 48% had multiple affected limbs. This is speculated to result out of adaptation of the CNS in an attempt to adapt to the altered condition by remodeling or neuronal plasticity.
2. The syndrome started in 1 limb in 88% of patients, 2 limbs in 11% of patients and 4 limbs in 1% patients.

3. CRPS spread in 78 patients. The severity of the CRPS did not vary greatly once spread.

4. Out of those who had spreading CRPS, 53% had spreading to the contra-lateral limbs and 32% in limbs. In 15% of cases, the spread was in a diagonal pattern (i.e. from L leg to R arm). So individuals with spontaneous spread to the contralateral limbs were 2.3x more likely for spread than ipsilateal and 25x more likely than diagonal spread.

5. The mechanism of ipsilateral spontanous spread is unclear.

6. Patients with multiple-CRPS, were significantly younger than those with single- CRPS. This may be due to genetic factors/predisposition for this syndrome.

7. Contralateral spreading of CRPS is thought to possibly arise via altered spinal processing of incoming sensory information in the spinal cord and brainstem. Spinal glial cells and pro-inflammatory cytokines may be important factors in this. Its spread probably involves different supraspinal mechanisms and noxious stimuli activate bilateral regions of the brain associated with descending pain pathways.

8. There is little data on ipsilateral spreading of symptoms but the authors speculate that glial mediated changes at one segement of the spinal cord reach other segments by axonal transport via descending or ascending fibre tracts.

van Rijn MA, Marinus J, Putter H, et al. Spreading of complex regional pain syndrome: not a random process. J Neural Transm 2011.

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21 replies »

  1. Thank you for sharing this- we need to build more online resources for those suffering from CRPS/RSD. Such a shame that those suffering with this debilitating pain barely have anywhere to turn for information and support.

  2. Thankyou for the information, I have severe crps type 1 in the right arm and have no use of it at all, I am also having problems with my right leg and now my left arm.
    I am very scared of what the future may bring with this syndrome.
    I can only hope it does not spread to all of my body,

    Kind regards

    • I have CRPS in my right hand and wrist. There is also worry for me , as I don’t know what the future holds for me.
      Sincerely Just Val

    • Hi It started in my ankle after a fall, ligaments were torn had surgery and I was not getting better!
      Ankle was changing colour red , blue , hot and cold, then it’s spread up my leg, very pain full throbing, burning , like a hammer was hitting my quad, had 4 nerve blocks, they do help, but most off all , you must keep that part of ur body moving the best u can , if it’s ur leg physio on a bike it helps me , it’s a shocking disease to have!!
      Just try and not think about the pain it’s hard not too , stress will make things worse

  3. Well this states that it can present itself in other areas, which many of those of us with CRPS already know, what it does not explain is a clear concise reason as to exactly why this happens. My pain specialist has already explained that the neuro transmitters in the spinal chord or the brain can be the reason for the pain rather than actual damage to the limb/limbs involved, as I already mentioned what I was expecting from this article was a answer to why this.

  4. Thank you very much. This information is needed by those affected by this condition and for all those in the health care profession.

  5. The article was good although it still doesn’t help when you tell your doctor you think this is happening and they look at you like you don’t know what your talking about and your left with the pain and no help

    • Hi , you need a pain doctor who knows this disease , normal gps don’t know munch about it, yes I know how they think your going crazy

  6. I have CRPS. I am a 41 year old female and my onset was at age 34. It started only in my feet and over the last several years it has spread all the way up my legs and the newest is that it is in my hips and lower back. I cannot sit up for too long because the agony in my joints is awful. I lay down in bed most of the time. I have an internal pain pump with Dilaudid and also take Morphine for breakthrough but it is agonizing still. I am afraid of it spreading to my arms. I do not know what I am going to do.

  7. Hello, I have had CRPS for 4 years in foot. I am Admin/Leader in a wonderful supportive RSD/CRPS group and would love for you to join JGF Organization: RSD/CRPS Support Group! Our goal is to support and help others and give updated information on this awful disease. We also chat with each other and share our stories’ and experience’s! Hope you decide to join us!

    https://www.facebook.com/groups/JGForgRSDCRPSsupport/

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  11. mINE ACTUALY STARTED IN MY STERNUM /RIBS.. THEN I BROKE LEFT FOOT, SO SPREAD TO THERE, THEN FELL WITH BROKEN FOOT SPLAYED 3 BOTTOM SPINAL BONES 3 DIFF WAYS AND THEN CRPS THERE… 😦

  12. I have CRPS in my left hand and arm. Stellate Ganglion blocks provided some relief; together with physical therapy. I do not know what tomorrow will bring……I have pains in my right hand and burning sensations in both feet and legs. Little to no strength in my left hand.

  13. This is actually the first time I’ve heard that I’m not completely alone in that mine started in my right arm, then my left leg, then my right leg, then to my left arm.
    It had just started spreading into my palms and several fingers when I began Ketamine Infusions. It actually retreated from my palms and hands! As long as I get infusions often enough it keeps it from spreading into my palms and fingers, and now also is keeping it from going past the middle of my feet towards my toes.

    Thank you so much for this, very informative, article!

  14. I had a bone spur removed from my thumb, didn’t heal like it should, ran out of FMLA@ work, lost job & insurance, I’m feeling burning in other hand now, I’m so scared

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