CRPS Treatment in Hoffman Estates: A Pain Doctor Complete Guide to Complex Regional Pain Syndrome

Last updated: May 2026. Author: Keith W. Schmidt, MD, Triple Board-Certified Interventional Pain Management Physician, Medical Director Neuroscience Institute Pain Program at Ascension Saint Alexius, Chair of the ASPN Healthy Longevity & Age-Related Pain Committee.

Complex Regional Pain Syndrome (CRPS) is one of the most underdiagnosed, undertreated, and misunderstood pain conditions in medicine. Most patients I see have lived with it for 12 to 24 months before getting an accurate diagnosis. Most have been told some version of “the pain is in your head” or “this should have resolved by now.” It is none of those things. CRPS is a real, mechanism-based neurologic condition with specific diagnostic criteria, a treatment ladder, and good outcomes when caught early and managed correctly. I treat CRPS regularly in my Hoffman Estates practice. This is the patient guide I wish every CRPS patient had on the day of diagnosis.

Table of Contents

• What is CRPS
• CRPS Type I vs Type II
• How CRPS is actually diagnosed (Budapest Criteria)
• The early-treatment window: why time matters
• The CRPS treatment ladder I use
• Sympathetic blocks and Bier blocks
• SCS and DRG for CRPS
• Medication strategy
• The multidisciplinary care that actually matters
• Realistic outcomes
• Frequently asked questions
• References

What is CRPS

Complex Regional Pain Syndrome is a chronic pain condition that develops in a limb after an injury, surgery, or sometimes minor trauma. The pain is dramatically out of proportion to the original injury, persists long after the injury should have healed, and has specific clinical features: skin color changes, temperature differences between the affected limb and the unaffected side, swelling, sweating changes, hair and nail changes, tremor, dystonia, and weakness.

CRPS used to be called Reflex Sympathetic Dystrophy (RSD) or causalgia. The name changed in the 1990s because the older terms suggested the sympathetic nervous system was the only mechanism. The newer term reflects what we have learned: CRPS involves nervous system, vascular, immune, and central nervous system mechanisms working together.

CRPS Type I vs Type II

CRPS Type I: develops without an identifiable nerve injury. Used to be called RSD. Most CRPS is Type I. Triggers: fractures (especially wrist), sprains, soft-tissue surgery, immobilization in a cast, even minor trauma.

CRPS Type II: develops after a specific identifiable nerve injury. Used to be called causalgia. The pain pattern follows the territory of the injured nerve, at least initially.

The treatment approach overlaps substantially between the two. The diagnostic distinction matters mainly for understanding what triggered it.

How CRPS is actually diagnosed (Budapest Criteria)

CRPS is a clinical diagnosis. There is no single blood test or imaging finding that confirms it. The current standard is the Budapest Criteria, which require:

1. Continuing pain disproportionate to any inciting event.

2. At least one symptom in three of these four categories (patient-reported):

• Sensory: hyperesthesia, allodynia (light touch hurts)
• Vasomotor: temperature asymmetry, skin color changes
• Sudomotor/edema: sweating changes, swelling
• Motor/trophic: weakness, tremor, dystonia, hair/nail/skin changes

3. At least one sign in two or more of those categories (observed at evaluation).

4. No alternative diagnosis better explains the symptoms.

That fourth point matters. CRPS is a diagnosis of exclusion plus pattern recognition. Bone scans, thermography, and X-rays can support the diagnosis but are not definitive on their own.

The early-treatment window: why time matters

Outcomes depend dramatically on how quickly treatment starts. Diagnosed and treated within 3 to 6 months of onset, most patients achieve substantial recovery. After 12 to 24 months, the condition becomes much harder to reverse because central sensitization sets in and the central nervous system itself starts maintaining the pain independent of the original trigger.

If you suspect CRPS, get a referral to an interventional pain physician within weeks, not months. This is one of the few pain conditions where speed of treatment dramatically changes outcomes.

The CRPS treatment ladder I use

I treat CRPS in a stepwise way, starting with the lowest-risk options and escalating based on response. The goal at every step: enable physical therapy desensitization, which is the cornerstone of recovery.

1. Physical therapy desensitization and graded motor imagery: the actual cure mechanism. Everything else exists to make PT tolerable.
2. Neuropathic pain medications: gabapentin or pregabalin, sometimes with low-dose nortriptyline or duloxetine.
3. Sympathetic nerve blocks: stellate ganglion (upper limb) or lumbar sympathetic (lower limb), typically a series of 3 to 6.
4. Bier block (intravenous regional anesthesia): especially for upper-limb CRPS that has not responded to stellate blocks.
5. Ketamine infusions: 4 to 5 day inpatient or outpatient protocols for refractory cases.
6. IV bisphosphonates: pamidronate or zoledronate, particularly when bone scan shows active inflammation.
7. Spinal Cord Stimulation (SCS): for refractory cases involving a broader area.
8. Dorsal Root Ganglion Stimulation (DRG): the highest-evidence neuromodulation option for focal CRPS in a single limb. The ACCURATE trial established DRG as superior to traditional SCS for this indication.

Sympathetic blocks and Bier blocks

For upper-limb CRPS, I use a stellate ganglion block: an injection of local anesthetic near a cluster of sympathetic nerves at the base of the neck. This temporarily interrupts sympathetic outflow to the affected arm. A series of 3 to 6 blocks, usually weekly, often produces meaningful and durable relief, especially when paired with aggressive PT.

For lower-limb CRPS, I use a lumbar sympathetic block: a similar concept, targeting sympathetic nerves alongside the lumbar spine. Same protocol: series of 3 to 6.

For upper-limb CRPS that does not respond adequately to stellate blocks, I sometimes use a Bier block (intravenous regional anesthesia): a tourniquet is placed on the upper arm and local anesthetic is infused through an IV in the affected hand, then released after 30 minutes. This delivers very high local anesthetic concentrations directly to the affected territory. Bier blocks are technically demanding and not every pain practice offers them; I do.

SCS and DRG for CRPS

For CRPS that has not responded adequately to the above (typically 3 to 6 months of optimized treatment), neuromodulation is the next step.

Spinal Cord Stimulation (SCS): implants thin leads in the epidural space and a small battery under the skin to deliver pulses that interrupt pain signals. Effective for broader CRPS or CRPS plus other neuropathic pain. Trial period of 5 to 10 days before permanent implantation.

Dorsal Root Ganglion Stimulation (DRG): the higher-evidence option for focal single-limb CRPS. The ACCURATE trial (Deer et al., 2017) showed DRG superior to traditional SCS at 3 and 12 months for CRPS Type I and II of the lower limb (81 percent treatment success vs 56 percent for SCS).

For full detail on how I choose between SCS and DRG, see my complete guide to neuromodulation.

Medication strategy

The medication ladder I use:

• First line: gabapentin or pregabalin, plus a topical (compounded ketamine/lidocaine cream or 5 percent lidocaine patches).
• Second line: add nortriptyline or duloxetine.
• Third line: low-dose naltrexone (off-label, increasingly used for chronic pain), or short courses of low-dose corticosteroids in early disease.
• Refractory: ketamine infusions, IV bisphosphonates.

I generally avoid long-term opioids for CRPS. They blunt the central sensitization signal but do not stop the underlying mechanism, and tolerance plus dependence become real problems over time.

The multidisciplinary care that actually matters

CRPS responds best to coordinated care across several disciplines:

• Interventional pain medicine (me): blocks, neuromodulation, medication.
• Physical and occupational therapy: graded desensitization, mirror therapy, graded motor imagery, pool therapy.
• Mental health: pain psychology, cognitive behavioral therapy. The chronicity is hard. Pain CBT helps.
• Primary care: managing comorbidities, sleep, depression.

I work with PT, OT, and pain psychology colleagues across the northwest suburbs and refer aggressively. CRPS treated by one specialty alone has worse outcomes than CRPS treated by a coordinated team.

Realistic outcomes

What patients can expect (rough averages):

• Diagnosed within 6 months and treated aggressively: 70 to 85 percent achieve substantial recovery, defined as meaningful pain reduction plus return to normal limb use.
• Diagnosed at 6 to 12 months: 50 to 65 percent achieve substantial recovery.
• Diagnosed beyond 12 months: 30 to 50 percent achieve meaningful improvement; complete recovery is harder. Goal shifts to functional pain management with the lowest possible medication burden.

Even chronic CRPS responds to treatment. The window for “complete reversal” closes, but the window for “substantial functional improvement” stays open indefinitely with the right interventional and multidisciplinary approach.

Frequently Asked Questions

How fast should I see a pain doctor if I think I have CRPS?

Within weeks of suspecting it. If a primary care or orthopedic provider mentions CRPS, RSD, or unexplained pain after an injury that should have healed, ask for a referral to an interventional pain specialist immediately.

Can CRPS spread to other limbs?

It can, in untreated or undertreated cases. Aggressive early treatment prevents most spread. If you notice symptoms in a second limb, treat that as urgent.

Will sympathetic blocks cure my CRPS?

Sympathetic blocks alone rarely cure CRPS, but they create a window of reduced pain that lets PT do its work. The PT during that window is what produces durable change. Blocks without PT are a temporary fix.

Do I need a stimulator?Most early-diagnosed CRPS patients do not need neuromodulation. We start with PT, meds, and sympathetic blocks. Neuromodulation is reserved for patients who have not responded adequately after 3 to 6 months of optimized treatment.

Will Medicare cover CRPS treatment?

Yes. Sympathetic blocks, Bier blocks, SCS, and DRG are all routinely covered under Medicare for documented CRPS. Commercial insurers in Illinois follow similar policies with prior authorization.

Can CRPS go away on its own?

Spontaneous remission happens but is uncommon, and “spontaneous” usually involves the patient doing intuitive desensitization (using the limb gradually despite the pain). Most CRPS gets worse without treatment.

Will the pain ever come back after I recover?

Stable recovery typically holds. Re-injury or surgery on the previously affected limb is the main trigger for recurrence. We discuss strategies (regional anesthesia for any future surgery, vitamin C prophylaxis after fractures) to reduce that risk.

How do you handle the psychological impact?

Pain psychology referral is part of the standard treatment plan, not a sign that I think the pain is in your head. Chronic pain causes depression and anxiety mechanistically. Treating those mechanistically improves the chronic pain.

References

1. Harden RN, Bruehl S, Stanton-Hicks M, Wilson PR. Proposed new diagnostic criteria for complex regional pain syndrome. Pain Medicine. 2007. (Budapest Criteria)
2. Deer TR, Levy RM, Kramer J, et al. Dorsal root ganglion stimulation yielded higher treatment success rate for complex regional pain syndrome and causalgia at 3 and 12 months. Pain. 2017. (ACCURATE trial)
3. Stanton-Hicks M. Complex regional pain syndrome: manifestations and the role of neurostimulation in its management. Journal of Pain and Symptom Management. 2006.
4. Sayed D, et al. (including Schmidt KW). ASPN Best Practices and Guidelines for the Interventional Management of Cancer-Associated Pain. Journal of Pain Research. 2021. PubMed 34295184

About the Author

Keith W. Schmidt, MD is a triple board-certified interventional pain management physician practicing in Hoffman Estates, Illinois. He is Medical Director of the Neuroscience Institute Pain Program at Ascension Saint Alexius Medical Center and Chair of the American Society of Pain and Neuroscience Healthy Longevity & Age-Related Pain Committee. He completed his Pain Medicine fellowship at Rush University Medical Center.

If you would like to discuss CRPS treatment, my office accepts referrals from across the northwest Chicago suburbs. Call (847) 981-3630 or request an appointment online.