An Occupational Therapist’s Perspective
As an occupational therapist working with people who experience persistent pain, I meet clients whose symptoms sometimes seem to go far beyond a typical injury or recovery process. They might describe burning sensations, swelling, changes in skin colour or temperature, and pain that feels disproportionate to the original cause. For many of these clients, the diagnosis that eventually explains these symptoms, particularly when these are confined to a particular part of the body, is Complex Regional Pain Syndrome, or CRPS.
CRPS can be a confusing and distressing condition—not just for those who experience it, but also for their families and even some healthcare professionals. It challenges our understanding of pain, recovery, and the mind-body connection. The key to managing CRPS lies in early identification, education, appropriate treatment approaches, collaboration, and empowering people to regain control over their bodies and lives.
What Is Complex Regional Pain Syndrome?
CRPS is a chronic pain condition that typically develops after an injury like a fracture, surgery, stroke, or even something as minor as a sprained ankle. The affected limb—usually an arm, hand, leg, or foot—becomes extremely sensitive and painful, sometimes without clear signs of ongoing damage.
The exact cause isn’t fully understood, but research shows that CRPS involves both the nervous system, and in particular the autonomic nervous system, the brain, and the immune system. After an injury, the body’s normal healing process seems to go into overdrive. The nerves continue to send danger signals even after the tissue has healed, and the brain’s interpretation of those signals becomes confused and amplified.
Common symptoms include:
- Continuous burning or throbbing pain
- Sensitivity to touch or temperature (even light contact can be excruciating)
- Swelling and stiffness
- Changes in skin temperature, colour, or texture
- Changes to sweating patterns, hair growth or texture, and nail growth or texture
- Muscle weakness or tremors
- Decreased ability to move the affected limb
While CRPS can improve over time, recovery is often gradual and requires a comprehensive approach that addresses both the physical, neurological, and emotional aspects of pain.
Living with CRPS
One of the most challenging aspects of CRPS is that it doesn’t just cause pain—it disrupts daily life. Simple tasks such as getting dressed, cooking, or typing can become difficult or impossible. Many people also experience sleep disturbances, fatigue, and emotional distress. It’s common to feel frustrated, anxious, or even disbelieved, especially when the pain seems out of proportion to the original injury.
As an occupational therapist, I’ve seen how these challenges can create a cycle of fear and avoidance. People start moving less because they fear exacerbating the pain, but the lack of movement can actually worsen symptoms by increasing stiffness and reducing blood flow in the affected area. An occupational therapist’s role is to help change that cycle gently and safely.
The Role of Occupational Therapy in CRPS
Occupational therapy is uniquely positioned to support people living with CRPS. We look at the whole person—their physical abilities, emotional well-being, routines, and environment. Our goal isn’t just to treat the pain but to help people return to meaningful activities and rebuild confidence in using the affected limb.
Here are some of the key ways occupational therapy can help:
1. Getting the right diagnosis – The Budapest Criteria
The Budapest Criteria are a set of diagnostic guidelines for Complex Regional Pain Syndrome (CRPS).
To be diagnosed with CRPS using the Budapest Criteria, all the following statements must be true:
- The patient has continuing pain that is disproportionate to any inciting event.
- The patient has at least one physical examination sign in two or more of the four categories (Sensory, Vasomotor, Sudomotor/Edema, Motor/Trophic).
- The patient reports at least one symptom in three or more of the four categories.
- No other diagnosis can better explain the signs and symptoms.
2. Education and Understanding
Knowledge is power with CRPS. I spend time helping clients understand what’s happening in their body and nervous system. When people realise that pain doesn’t always mean damage, it can reduce fear and anxiety. This understanding is the first step toward re-engaging with movement.
3. Graded Motor Imagery and Mirror Therapy
These techniques are based on how the brain represents movement. In CRPS, the brain can become “confused” about the affected limb, amplifying pain signals. Graded motor imagery uses visualisation, mirror therapy, and gentle movement exercises to retrain the brain’s perception and reduce pain. Over time, these techniques help restore function and control.
4. Desensitisation and Sensory Re-education
When touch or temperature becomes unbearable, we start with very gentle desensitisation techniques. Using textures, vibration, or water immersion, we gradually reintroduce normal sensory experiences to the limb. This process helps the nervous system “relearn” what safe touch feels like.
5. Functional Movement and Graded Activity
Working together, we restore movement gradually and safely. This might begin with very small, supported motions and progress to real-life tasks such as dressing, cooking, or typing. Every small step builds confidence and helps re-establish normal movement patterns.
6. Pain Management and Pacing
Because CRPS symptoms can fluctuate, pacing is essential. Clients are taught how to balance activity and rest, recognising early signs of fatigue or flare-ups. Relaxation techniques, mindfulness, and controlled breathing also help regulate the nervous system and lower pain intensity.
7. Environmental and Lifestyle Modifications
Sometimes small changes at home or work can make a huge difference—adjusting a workstation, using adaptive equipment, or changing the layout of a kitchen to reduce strain. These practical adjustments help clients conserve energy and participate more fully in everyday life.
Working in the Cape Town Context
In Cape Town, we have a variety of clients—office workers, artisans, athletes, and retirees—each with their own unique stories and lifestyles. The city’s diverse and active environment can make CRPS particularly isolating. When you live in a place where outdoor activity is part of the culture, being unable to hike, swim, or even drive comfortably can take an emotional toll.
Our approach blends international best practice with a local understanding of lifestyle, climate, and access to care. Collaboration with physiotherapists, pain specialists, and psychologists is vital. Together, we create holistic treatment plans that support both the body and mind.
The Emotional Impact of CRPS
Pain and emotion are deeply connected. People with CRPS often experience anxiety, frustration, or depression as a result of their symptoms. These emotions can, in turn, heighten pain perception—a cycle that’s hard to break.
That’s why we encourage open conversations about the emotional impact of CRPS. Working with healthcare providers who understand pain can be incredibly beneficial. Group therapy or support groups can also provide reassurance that you’re not alone in your experience.
Recovery and Hope
While there’s no single “cure” for CRPS, many people do experience significant improvement over time, especially when therapy begins early. Recovery is rarely linear—there are ups and downs—but progress is absolutely possible.
Success is not only measured by reduced pain but by increased participation—seeing someone return to work, prepare a meal with both hands, or take a walk on the beach again. These milestones reflect not just physical healing but the restoration of confidence and independence.
Complex Regional Pain Syndrome can feel overwhelming, but it doesn’t define who you are. With the right support, education, and consistent therapy, it’s possible to retrain the body and brain, reduce pain, and rebuild a meaningful life.