Hi Kim,

Me too. Woke up from back surgery with it. Yes, CRPS Type II there is nerve damage involvement. So I went looking for a quick statement of the two types and I found this just from the top couple of google results. I believe it to be fairly accurate, albeit kind of long and depressing to read. But here goes..

Complex regional pain syndrome
From Wikipedia, the free encyclopedia


Complex regional pain syndrome (CRPS), formerly reflex sympathetic dystrophy or causalgia, is a chronic systemic disease characterized by severe pain, swelling, and changes in the skin. CRPS is expected to worsen over time.[1] It often initially affects an arm or a leg and often spreads throughout the body; 92% of patients state that they have experienced a spread and 35% of patients report symptoms in their whole body.[2] Recent evidence has led to the conclusion that Complex Regional Pain Syndrome is a multifactorial disorder with clinical features of neurogenic inflammation, nociceptive sensitisation (which causes extreme sensitivity or allodynia), vasomotor dysfunction, and maladaptive neuroplasticity, generated by an aberrant response to tissue injury.[3] Treatment is complicated, involving drugs, physical therapy, psychologic treatments and neuromodulation and usually unsatisfactory, especially if begun late.[4]

CRPS is associated with dysregulation of the central nervous system[5] and autonomic nervous system resulting in multiple functional loss, impairment and disability. The International Association for the Study of Pain has proposed dividing CRPS into two types based on the presence of nerve lesion following the injury.

• Type I, formerly known as reflex sympathetic dystrophy (RSD), Sudeck's atrophy, reflex neurovascular dystrophy (RND), or algoneurodystrophy, does not have demonstrable nerve lesions. With the vast majority of patients diagnosed with CRPS being of this type, most of the literature thus refers to type I.

• Type II, formerly known as causalgia, has evidence of obvious nerve damage. Type II CRPS tends towards the more painful and difficult to control aspects of CRPS; type II scores 42 out of 50 on the McGill pain scale [6] (however there is seemingly little or no data pertaining to type I specifically here). In Type II the "cause" of the syndrome is the known or obvious nerve injury, although the cause of the mechanisms of CRPS Type II are as unknown as the mechanisms of Type I.


CRPS has the unfortunate honour of being described as being one of, if not the most painful long term condition, scoring 42 out of a possible 50 on the McGill pain scale, above such events as amputation and childbirth.[7] Lack of social awareness has inspired patients to campaign for more widespread knowledge of CRPS[8] and lack of clinical awareness has led to the creation of support groups seeking to self-educate with the latest research.[9]

Evidence suggests that CRPS has both physical and psychological factors. CRPS is said to cause physiological problems (rather than physiological problems causing CRPS); whilst "research does not reveal support for specific personality or psychopathology predictors of the condition" there are psychosocial factors to CRPS (such as reduced quality of life and impaired occupational function) and psychological problems (which include increased depression and anxiety).[10] Unsurprisingly, there is overwhelming evidence of limbic system involvement.[11] Sadly this very poor quality of life for some has led to high rates of depression and suicide among sufferers, which has motivated appeals for greater understanding. The AFPS leaflet on CRPS and prevention of suicide is available online here:.[12]

Daily vitamin C has been shown to reduce the chance for the occurrence of CRPS after an injury, leading to calls for greater awareness, especially in the emergency room setting.[13] In two placebo-controlled randomized clinical trials Zollinger et al. showed that patients who took 500 mg of vitamin C daily after a wrist fracture were less likely to incur the problem.[14] The cause of CRPS is currently unknown. Precipitating factors include injury and surgery, although there are documented cases that have no demonstrable injury to the original site.

With the growing body of evidence persuasively indicating the progressive and systemic implications of chronic CRPS,[15] there is concern that these patients may be erroneously also diagnosed with fibromyalgia. Fibromyalgia has a MPQ score of 35.7/50,[16] whereas CRPS averages a 42/50 MPQ. Chronic CRPS patients would react to the pressure points of the brachial plexus, the intercostobrachial (ICB) nerve and concomitant L5-S1, injury.[17] Similarly, when patients with multiple sclerosis were tested for CRPS, incidents of the disease was more than 50 times higher than in the average population.[18] This has led to calls for research and more understanding of chronic CRPS symptoms which may include muscle twitching and tremors, wobbliness, falling and visionary disturbances.[9]

As Complex Regional Pain syndrome is a systemic disease, any organ could potentially be affected.[19] There are many internal complications which are frequently not acknowledged, "CRPS affects the systems of: cognition; constitutional, cardiac, and respiratory complications; systemic autonomic dysregulation; neurogenic edema; musculoskeletal, endo-crine and dermatological manifestations; as well as urological and gastrointestinal function".[20]