It is very rare but I have been told of 2 cases where there is no pain. Below is a full list of symptoms for a correct diagnosis of CRPS you need 3 of the main 4 and some of the others which may com and go or change from one to another over time

There are FOUR Main Symptoms/Criteria for a diagnosis of CRPS:
• Constant chronic burning pain - (includes allodynia; extreme sensitivity to touch, sound, vibration, wind, etc.)
• Inflammation - this can affect the appearance of the skin, bruising and mottling for example.
• Spasms-in blood vessels and muscles of the extremities
• Insomnia/Emotional Disturbance (including limbic system changes such as short-term memory problems, concentration difficulties, and irritability)
Not all four symptoms are required for a diagnosis but most patients do have at least three out of the four at any one time. What makes this disease even more difficult for Drs to diagnose and treat is that patients can present with different symptoms at different times, even from one appointment to the next.

The CONSTANT PAIN can be described as burning pain as if a red hot poker were inserted into the affected area; as well as throbbing, aching stabbing, sharp, tingling, and/or crushing in the affected area (this is not always the site of the trauma). The affected area is usually hot or cold to the touch. The pain will be more severe than expected for the type of injury sustained. This is a hallmark of the disease. Allodynia is usually present as well (extreme sensitivity to touch). Something as simple as a light touch, clothing, sheets, even a breeze across the skin on the affected area can cause an extreme amount of pain to the patient. Pain can also be increased by sounds and vibrations, especially sharp sudden sounds and deep vibrations. This makes it increasingly difficult on the spouses, children, and other family members; as their softest touch can now cause pain instead of comfort. If the patient has not been properly diagnosed yet and these sensations not properly explained, these symptoms can cause extreme duress and confusion to all involved.

The INFLAMMATION is not always present. It can take various forms, the skin may appear mottled, become easily bruised, bleeding in the skin, small red dots, have a shiny, dry, red, and tight look to it. An increase in sweating usually occurs as well as swelling in and around the joints (shoulders, knees, wrists). In some patients a lack of sweating may also occur, and may even go back and forth between the two.

The SPASMS result in a feeling of coldness in the affected extremity as well as body fatigue, skin rashes, low-grade fever, swelling (edema), sores, dystonia, and tremors. The spasms can be confined to one area or be rolling in nature; moving up and down the leg, arm, or back.

The fourth part of this square is INSOMNIA and EMOTIONAL DISTURBANCE. CRPS affects the limbic system of the brain. Doctor Hooshang Hooshmand described it well; " The fact that the sympathetic sensory nerve fibers carrying the sympathetic pain and impulse up to the brain terminate in the part of the brain called "limbic system". This limbic (marginal) system which is positioned between the old brain (brainstem) and the new brain (cerebral hemispheres) is mainly located over the temporal and frontal lobes of the brain." This causes many problems that might not initially be linked to a disease like CRPS. Chief among them are Depression, Insomnia and short-term memory problems. CRPS can cause Depression, NOT the other way around.


ADDITIONAL SYMPTOMS

There are many additional symptoms that can be part of CRPS besides the four main ones. These include but are not limited to;

- Changes in skin temperature (warmer or cooler compared to the healthy/opposite limb.
- changes in skin color (skin may appear red, dusky, covered with red dots, cyanotic, blotchy, or pale).
- hypersensitivity to touch, sound, vibration, wind, noise, temperature, barometric pressure changes, water temperature, etc.
- irritability.
- depression, fatigue, and/or insomnia.
- changes in hair/nail growth (nails can become brittle, cracked, or grooved - increased/decreased hair/nail growth).
- skin can become shiny, changes in sweating patterns - increase/decreases
- bone and muscle loss/changes, atrophy/weakness.
- swelling and stiffness in affected joints.
- throbbing, crushing, tingling, shooting, aching, stabbing, burning pain in the affected area.
- tremors (shakes).
- problems moving the affected extremity/body part.
- migraines/cluster headaches.

These symptoms can come and go and alternate over time, changing from month to month and year to year depending what stage the patient is in

This will spread in 77% of sufferers and in 10% will go full body, (all 4 limbs, neck, head, eyes and internal organs.
8% of sufferers may get wounds which never heal.