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Complex Regional Pain Syndrome (CRPS)

“A insidious source of pain that can be treated without surgery or undue suffering”

Complex regional pain syndrome is a chronic pain syndrome that can develop with or without an inciting event. It is often more severe than the original injury and can result in pain and functional loss of the affected extremity. It can be caused by a minor fracture, sprain or strain, or with no specific event whatsoever. It is most common in people aged 36-46 years and more common in females and in immobilized joints and tissues.

Why your Complex Regional Pain Syndrome hurts.

The pain is thought to be caused by sensitization of the sympathetic nervous system or an immune response which results in sensitization of primary nociceptor afferents resulting in the release of inflammatory mediators causing pain and local tissue breakdown.


• Erythematous or cyanosed blotchy skin
• Skin atrophy
• Skin edema occurs in up to 81% of patients
• Loss of normal skin creases
• Reduced or excessive sweating
• Increased or decreased temperature
• Restricted passive range of motion, contractures
• Osteoporosis
• Muscle wasting and weakness
• Muscle spasms, dystonia, tremor
• Normal sensory stimuli causing pain known as allodynia

If you are experiencing pain or weakness in an extremity you could be suffering from complex regional pain syndrome.
Our expert doctors at Spine & Sports Medicine of New York use expertise in innovative assessments to accurately diagnose the cause of your pain.

Other diseases that can mimic complex regional pain syndrome include:

• Fracture
• Neuropathy/neuropathic pain
• RadiculopathyOur Board-Certified Physicians Can Accurately Diagnose the Source of Your Pain

We conduct a thorough clinical evaluation to determine if the pain is generated from complex regional pain syndrome as well as other conditions that share similar symptoms. We begin our evaluation of your problem with a complete medical history using detailed information gathering tools followed by a focused physical examination. We then confirm our diagnosis with specialized tests which may include x-rays, CT and electrodiagnostic (EMG) studies, ultrasonography, or MRI.

“No surgery is needed to relieve your complex regional pain syndrome”


The first step in treatment is a trial of medication to decrease the symptoms. Medications that have been found to be helpful include gabapentin, tricyclic antidepressants, duloxetine, opioids, bisphosphonates, and prednisone. Also removing aggravating factors can also be helpful in calming down the abnormal nervous system response. Exercise is most often prescribed which is used to limit the loss of function of the extremity. These include joint range of motion, coordination/dexterity, compression devices for edema management and contrast bath for desensitization. If these conservative treatments are not helpful, innovative interventions such as sympathetic blocks and spinal cord stimulator can also be used.

Here’s what you can expect if one of our pain specialists treats your pain:

• Relief of pain to get you back to living.
• Several treatment options available to target the root of the problem
• May be accompanied by physical therapy to strengthen, improve range of motion and to desensitize the area
• Body mechanics awareness to eliminate the source of the pain
• Many patients gain considerable to complete relief with a sympathetic block or a spinal cord stimulator
• No general anesthesia, surgery or prolonged recovery periods to slow you down from your busy schedule
• Thousands of patients have been helped by our innovative approach to complex regional pain syndrome.


Atkins RM.Complex regional pain syndrome.J Bone Joint Surg Br.2003 Nov;85(8):1100-6.

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Dr. Panagos took extreme care for my condition on many occasions. He was also instrumental in enabling me too make a trip to France for our Daughters birthday. I was in excruciating back pain and he gave me the formula to be able to sustain myself for a week during that time. He did all of this OUTSIDE of his office time, from his home during the evening. That is my kind of a caring Doctor. 

Oscar Y
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