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Complex Regional Pain Syndrome

Villanueva Institute of Pain and Spine

Complex Regional Pain Syndrome in Burbank, CA | CRPS

Complex regional pain syndrome, often called CRPS, is a painful and often confusing condition that can develop after an injury, surgery, fracture, sprain, or another medical event. The original injury may have healed on paper, but the pain keeps going. For many people, the pain feels far more intense than expected and may come with swelling, color changes, temperature changes, stiffness, weakness, or extreme sensitivity to touch.

CRPS can be hard to live with because it does not always make sense to the people around you. You may look “fine” from the outside, while even a bedsheet, sleeve, shoe, light touch, or small movement feels unbearable. Some patients are told their imaging looks normal or that the injury should no longer hurt, even though they are still struggling to walk, sleep, work, drive, use their hand, or trust the affected limb.

I am Dr. John Villanueva, double board-certified in PM&R and interventional pain management. At the Villanueva Institute of Pain and Spine (VIPS), I evaluate CRPS by looking closely at the full pattern: how the pain started, what has changed, what the limb looks and feels like, what treatment has already been tried, and how much of your life has been organized around avoiding pain.

Patients with CRPS have often already been brushed off or rushed through appointments by the time they reach a pain specialist. I do not want that to happen at VIPS. Your symptoms deserve ample time and attention here, and the plan we put together treats both the pain and the function you have lost.

If you are looking for CRPS treatment in Burbank, CA, call VIPS at (818) 669-8895 or request an appointment online. We are located in Burbank and proudly serve patients visiting from Glendale, Pasadena, Van Nuys, Toluca Lake, Studio City, Sherman Oaks, North Hollywood, Sun Valley, La Cañada, La Crescenta, Los Feliz, Atwater Village, Silver Lake, Echo Park, and communities throughout the San Fernando Valley and greater Los Angeles area.

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What Is Complex Regional Pain Syndrome?

Complex regional pain syndrome is a chronic pain condition that most often affects an arm, hand, leg, or foot. It often begins after an injury or procedure, although the triggering event may seem small compared with the pain that follows.

CRPS involves a change in how the nervous system responds. Pain signals can become amplified. The affected area may also develop changes in blood flow, swelling, sweating, skin temperature, skin color, movement, and sensitivity. That is why CRPS can feel so different from ordinary injury pain.

Some patients describe the pain as burning, electric, stabbing, crushing, deep, or raw. Others describe the affected limb as feeling foreign, heavy, swollen, cold, hot, or too sensitive to touch. Clothing, water, air movement, pressure, or simple movement can become difficult to tolerate.

You may also hear CRPS called RSD, or reflex sympathetic dystrophy. That is an older term, but many patients still know the condition by that name.

What Are the Symptoms of CRPS?

CRPS can look different from one patient to another, and symptoms may shift over time. Some people have mostly burning pain and sensitivity. Others have more swelling, stiffness, color changes, or weakness.

Common CRPS symptoms include:

  • Burning, shooting, electric, stabbing, or deep aching pain
  • Pain that feels out of proportion to the original injury
  • Sensitivity to touch, pressure, clothing, water, temperature, or movement
  • Swelling in the affected hand, arm, foot, or leg
  • Skin color changes, including red, blue, purple, pale, or blotchy skin
  • Temperature changes, with the limb feeling warmer or colder than the other side
  • Sweating changes
  • Stiffness, weakness, tremor, or reduced range of motion
  • Changes in hair growth, nail growth, or skin texture
  • Difficulty walking, gripping, writing, lifting, standing, driving, or using the affected limb
  • Pain that disrupts sleep, work, exercise, family life, or daily routines


CRPS can also change how you relate to your body. When every movement feels risky, it is natural to guard the limb or avoid using it. Over time, that can lead to more stiffness, weakness, fear of movement, and loss of independence. Treatment has to account for that cycle, not just the pain score.

CRPS Type I and CRPS Type II

CRPS is usually described as Type I or Type II.

  • CRPS Type I means there is no clearly confirmed major nerve injury. This is the type that used to be called reflex sympathetic dystrophy, or RSD.
  • CRPS Type II means there is a known nerve injury connected to the symptoms. This type was previously called causalgia.


In real life, the distinction is not always the most important part of the first conversation. What matters first is whether the symptoms fit CRPS, whether another condition is being missed, and what can be done to reduce pain while protecting movement and function.

Why Early CRPS Treatment Matters

CRPS is usually easier to treat when it is recognized earlier. Pain, guarding, stiffness, swelling, and sensitivity can become more difficult to reverse the longer they continue.

The first thing I need to do is understand the pattern of your symptoms. I want to see whether this fits CRPS, whether something else is also contributing, and which treatments give you the best chance of bringing the pain down, protecting the movement you still have, and feeling more confident using that limb again.

What Causes Complex Regional Pain Syndrome?

CRPS often begins after an injury or medical event, such as a fracture, sprain, surgery, crush injury, injection, nerve injury, or period of immobilization. Sometimes the trigger is obvious. However, in other instances, the initial event may have been minor.

The condition appears to involve an abnormal response from the nervous system. The body may continue producing pain and inflammatory signals even after the original injury should be improving. Blood flow, temperature regulation, swelling, and movement can also become disrupted.

This does not mean the pain is imagined but that the pain system is behaving abnormally. For many patients, simply having that explained clearly is a relief because they have spent months being told that their symptoms do not add up.

Treatments That May Help CRPS

CRPS usually needs more than one type of treatment. The plan may include rehabilitation, medication management, desensitization, nerve blocks, psychological support, and advanced pain procedures for certain patients.

Physical Therapy and Rehabilitation

Physical therapy is often central to CRPS treatment. The affected limb needs movement, but movement has to be approached carefully. Pushing too hard can flare symptoms. Avoiding movement completely can make stiffness, weakness, and sensitivity worse.

As a PM&R physician, I pay close attention to this balance. Rehabilitation should help you protect motion, rebuild strength, improve tolerance, and gradually use the affected limb with more confidence.

Desensitization work helps the nervous system tolerate touch, texture, pressure, temperature, and movement again. This may involve gradual exposure to different sensations or carefully guided exercises.

This is not about pretending the pain is not there. It is about retraining an overactive pain system, so the limb becomes less reactive over time.

Some CRPS symptoms involve the sympathetic nervous system, which plays a role in blood flow, sweating, temperature, and certain pain responses.

A lumbar sympathetic block may be used when CRPS affects the leg or foot. A stellate ganglion block may be used when CRPS affects the arm or hand. These blocks can sometimes reduce pain, sensitivity, temperature changes, or swelling enough to help the patient participate more comfortably in therapy.

Spinal cord stimulation may be an option for certain patients with severe or persistent CRPS that has not responded well enough to other care. SCS uses mild electrical stimulation near the spinal cord to change how pain signals are processed.

This is not usually the first step. It requires careful evaluation, a temporary trial, realistic expectations, and close follow-up. When CRPS is severe and disabling, however, SCS can be an important treatment to discuss.

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CRPS affects more than the injured limb. It can affect sleep, mood, relationships, work, independence, and your trust in your own body.

Psychological support does not mean the pain is “in your head.” Chronic pain is heavy to carry, and patients often do better when the emotional, functional, and nervous system sides of CRPS are addressed together.

A lumbar sympathetic block is an injection that targets sympathetic nerves in the lower back. It may be recommended when CRPS affects the leg, ankle, or foot.

During the block, medication is placed near the sympathetic chain to see whether quieting that pathway changes your pain, sensitivity, color changes, temperature changes, or swelling. Some patients notice meaningful relief. Others have a more limited response.

The block can also create a window for progress. If pain decreases, even temporarily, you may be able to walk more comfortably, participate in physical therapy, tolerate touch, or begin using the limb with less fear.

A lumbar sympathetic block is not a cure for CRPS. It is one tool that can be useful when the symptoms and exam suggest the sympathetic nervous system is part of the pain pattern.

Medication may help calm nerve pain, improve sleep, reduce inflammation, or make therapy more tolerable. The right plan depends on your symptoms, medical history, prior medication response, and safety considerations.

Medication alone rarely solves CRPS, but it can make the rest of the plan more manageable.

How Is CRPS Diagnosed?

CRPS is usually diagnosed through a careful clinical evaluation. There is no single test that proves CRPS in every patient, so the details matter.

During the exam, I look for pain sensitivity, swelling, color changes, temperature differences, sweating changes, stiffness, weakness, range of motion loss, and neurological findings. I also want to understand what happened before the symptoms began and how the condition has changed since then.

Testing may be used to support the evaluation or rule out other causes. Depending on your symptoms, that may include X-rays, MRI, ultrasound, bone scan, lab work, or EMG/NCS testing. EMG and nerve conduction studies can be helpful when numbness, tingling, weakness, or a possible nerve injury needs to be evaluated more closely.

CRPS can overlap with nerve compression, peripheral neuropathy, spine-related nerve pain, arthritis, vascular problems, infection, and inflammatory conditions. A careful diagnosis helps keep the treatment plan from going in the wrong direction.

Considerations for CRPS and Your Broader Treatment Plan

CRPS care is rarely a single appointment, prescription, or procedure. Depending on your symptoms, this specialized plan may include physical therapy, desensitization, medication management, EMG/NCS testing, sympathetic nerve blocks, spinal cord stimulation evaluation, or coordination with another specialist.

If your symptoms suggest sympathetic nerve involvement, a lumbar sympathetic block or stellate ganglion block may help. If pain is severe, long-standing, and refractory, spinal cord stimulation may be worth discussing. If testing points toward a different nerve injury, spine-related problem, vascular issue, or surgical concern, the plan may need to change.

At VIPS, I take time to review your symptoms, exam findings, records, prior treatment response, and daily limitations before recommending a direction. CRPS treatment should help you spend less time protecting the painful limb and more time rebuilding comfort, confidence, and function.

Good Candidates for CRPS Treatment

You may benefit from a CRPS evaluation if you have ongoing limb pain after an injury, surgery, fracture, sprain, or other event, especially when the pain feels more severe than expected.

Patients often come in with:

  • Burning, shooting, electric, or severe limb pain
  • Pain that continues after the original injury should have improved
  • Swelling, color changes, temperature changes, or sweating changes
  • Extreme sensitivity to touch, clothing, water, or movement
  • Stiffness, weakness, tremor, or decreased range of motion
  • Pain after a fracture, surgery, sprain, crush injury, or nerve injury
  • Symptoms in the hand, arm, shoulder, foot, ankle, leg, or knee
  • Pain that limits sleep, walking, gripping, working, driving, exercise, or daily routines
  • Symptoms that have not improved enough with medication, therapy, rest, or prior procedures


You do not need to know whether you have CRPS before coming in. Often, the purpose of the visit is to sort out whether CRPS, another nerve condition, or more than one issue is involved.

How I Evaluate You for CRPS

CRPS patients often have long and frustrating medical stories. I want to hear that story carefully because small details can change the direction of care.

During your consultation, I may review:

  • The injury, surgery, illness, or event that happened before symptoms began
  • Where the pain started and whether it has spread
  • Whether the pain feels burning, electric, stabbing, aching, cold, hot, or pressure-like
  • Sensitivity to touch, clothing, water, temperature, or movement
  • Skin color, skin temperature, swelling, sweating, hair, nail, or texture changes
  • Weakness, stiffness, tremor, guarding, or limited range of motion
  • Prior imaging, medications, therapy, procedures, or surgical history
  • Whether EMG/NCS testing may help clarify nerve involvement
  • How pain affects sleep, walking, work, driving, family life, and independence
  • What kind of improvement would matter most to you


Whenever possible, I prefer to review actual imaging and records rather than only brief summaries. Many CRPS patients have already seen several providers, and those records can help show what has been ruled out, what has been tried, and where we should begin.

Why Choose VIPS for Complex Regional Pain Syndrome?

CRPS treatment requires patience, clinical judgment, and a willingness to look beyond the obvious. At VIPS, the purpose of the visit is not to rush you into a procedure. It is to understand the pain pattern and build a plan that fits what is actually happening.

When you choose VIPS, you can expect:

I am double board-certified in PM&R and interventional pain management. My PM&R training helps me understand movement, strength, function, rehabilitation, and disability, while my interventional training allows me to perform targeted pain procedures when appropriate. In addition to my double-board certification, my certification as a Life Care Planner reflects advanced training in assessing long-term medical and rehabilitation needs. This expertise allows me to provide a comprehensive perspective when evaluating future care needs and serving as a medical-legal consultant and expert medical witness.

CRPS can overlap with nerve injuries, spine problems, vascular issues, arthritis, neuropathy, and inflammatory conditions. I review your history, exam findings, imaging, nerve symptoms, and prior care before recommending treatment.

Pain relief matters, but so does what relief allows you to do. I want to know whether CRPS is limiting walking, writing, gripping, sleeping, working, exercising, driving, or using the affected limb without fear.

Procedures such as lumbar sympathetic blocks, stellate ganglion blocks, nerve blocks, and other targeted treatments may require fluoroscopy or ultrasound guidance. I choose the approach based on the diagnosis, anatomy, and clinical need.

CRPS often requires several tools working together. Care may include medication management, physical therapy, desensitization, nerve blocks, spinal cord stimulation evaluation, psychological support, or coordination with another specialist.

If a nerve block, medication plan, therapy referral, SCS evaluation, or surgical opinion makes sense, I will explain why. If a treatment is unlikely to help, I will be direct about that too.

Many CRPS patients have already felt dismissed or misunderstood. I want you to feel acknowledged, informed, and comfortable asking questions before any treatment is performed.

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Treating CRPS in Burbank, CA

VIPS is located in Burbank, CA, in the Magnolia Park neighborhood. The office is designed to feel welcoming and personal, with comfortable seating, warm finishes, and original artwork from patients who are working artists. I live and work in Burbank, and I care about building a practice where patients feel known. This matters to me, and it matters for CRPS because patients often arrive with complicated symptoms and understandable frustration.

We see patients from Burbank, Glendale, Pasadena, Van Nuys, Toluca Lake, Studio City, Sherman Oaks, North Hollywood, Sun Valley, La Cañada, La Crescenta, Los Feliz, Atwater Village, Silver Lake, Echo Park, and communities throughout the San Fernando Valley and greater Los Angeles area.

Burbank CRPS FAQs

If burning pain, sensitivity, swelling, color changes, temperature changes, or difficulty using an arm, hand, leg, or foot is changing how you move through life, CRPS should be evaluated carefully.

To schedule a complex regional pain syndrome consultation in Burbank, CA, call (818) 669-8895 or contact VIPS online today. The right care may help you spend less time bracing against pain and more time rebuilding movement, confidence, and peace of mind.

RSD, or reflex sympathetic dystrophy, is an older term that is now generally included under CRPS Type I. CRPS Type II refers to similar symptoms when there is a confirmed nerve injury. Many patients still use the term RSD because that was the diagnosis they were first given.

Early signs may include burning pain, severe sensitivity, swelling, stiffness, skin color changes, temperature changes, or pain that feels much worse than expected after an injury. If symptoms are not improving or seem unusual compared with the original injury, it is worth seeking a careful evaluation.

Yes. CRPS can develop after surgery, fracture, sprain, crush injury, nerve injury, or other medical events. It can also occur after an injury that seemed relatively minor at first. The key issue is the ongoing pain pattern and associated nerve, skin, swelling, temperature, or movement changes.

CRPS does not always show clearly on imaging. X-rays, MRI, bone scan, ultrasound, or other testing may show supportive findings in some cases, but imaging is often used to rule out other problems as well. A normal scan does not automatically mean the pain is not real.

Some patients report symptoms spreading beyond the original area, although this does not happen to everyone. If pain, sensitivity, swelling, color changes, or temperature changes appear in another area, that should be discussed during evaluation so the pattern can be reviewed carefully.

A lumbar sympathetic block is an injection that targets sympathetic nerves in the lower back. It may be considered when CRPS affects the leg or foot. The block may reduce pain, temperature changes, sensitivity, or swelling in some patients, and it may help make rehabilitation more tolerable.

A stellate ganglion block targets sympathetic nerves in the neck region and may be considered when CRPS affects the arm or hand. The response can help determine whether sympathetic nerve activity is contributing to the pain pattern.

Spinal cord stimulation may help some patients with CRPS when pain is severe, chronic, and not controlled well enough with other treatments. It is usually considered after a careful evaluation and trial period. If the trial does not help enough, a permanent device is not implanted.

Some patients improve significantly, especially when treatment begins early. Others have symptoms that last longer or require ongoing management. I will be honest with you about expectations based on your symptoms, duration of pain, functional limitations, and response to treatment.

You should consider seeing a pain management physician if you have ongoing limb pain after injury or surgery, especially if the pain is burning, severe, unusually sensitive, or associated with swelling, color changes, temperature changes, stiffness, or weakness. At VIPS in Burbank, I evaluate CRPS patients from Glendale, Pasadena, Van Nuys, Toluca Lake, Studio City, Sherman Oaks, North Hollywood, and nearby Los Angeles communities.

The cost of CRPS treatment in Burbank can vary depending on the evaluation, testing, medications, physical therapy, injections, nerve blocks, spinal cord stimulation trial, or other treatments recommended. During your consultation, my team can help you understand what information may be needed for scheduling, authorization, and cost review.

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