Overview
Complex Regional Pain Syndrome (CRPS) is a chronic pain condition characterized by severe, burning pain, swelling, skin changes, and altered sensitivity — typically in one limb — that is disproportionate to any original injury or cause. It is divided into two types: CRPS Type I (no confirmed nerve injury, previously called reflex sympathetic dystrophy or RSD) and CRPS Type II (with confirmed nerve injury). CRPS is notoriously difficult to treat, and patients often struggle for years without adequate diagnosis or care. Dr. Migdale has specific fellowship training in CRPS and has presented original research on DRG stimulation for CRPS at a national neuromodulation conference.
What Causes CRPS?
CRPS is believed to result from an abnormal response of the central and peripheral nervous systems following an injury — sometimes even a minor one. The nervous system becomes dysregulated, amplifying pain signals and producing a cascade of changes including altered blood flow, temperature dysregulation, skin and hair changes, and hypersensitivity to touch (allodynia). The exact mechanism is not fully understood, which makes CRPS one of the most actively researched areas in pain medicine.
Signs and Symptoms
CRPS typically presents with: burning or throbbing pain in one extremity; hypersensitivity to touch or temperature; swelling and changes in skin temperature (warmer or cooler than the opposite limb); changes in skin color (mottled, blotchy, or pale); changes in hair and nail growth; muscle weakness and reduced range of motion; and allodynia — pain from stimuli that are not normally painful, such as light touch or clothing.
Interventional Treatment for CRPS
Dr. Migdale offers the full spectrum of interventional treatments for CRPS, including: sympathetic nerve blocks (stellate ganglion blocks for upper extremity CRPS, lumbar sympathetic blocks for lower extremity); spinal cord stimulation (SCS), which has strong evidence for CRPS; dorsal root ganglion (DRG) stimulation — which Dr. Migdale has presented research on at the NANS 2026 Annual Meeting; and ketamine infusions where appropriate. Early intervention is critical — the longer CRPS goes untreated, the more entrenched the sensitization becomes.