If you’ve recently been diagnosed with Complex Regional Pain Syndrome, you’re likely wondering what comes next. The treatment journey for CRPS typically follows a phased approach, progressing from conservative therapies to more advanced interventions based on your response and symptom duration. Understanding this timeline can help you set realistic expectations, make informed decisions with your healthcare team, and recognize when it might be time to consider additional treatment options. Most importantly, knowing that treatment exists at every stage—and that many patients find relief—can provide hope during a challenging time.
Why CRPS Treatment Follows Phases
CRPS treatment isn’t one-size-fits-all, and that’s actually a good thing. Your treatment plan should evolve based on several factors: how long you’ve had symptoms, which symptoms are most prominent, how you’ve responded to previous treatments, and your overall health status.
Research shows that CRPS responds best to early, aggressive treatment (Harden et al., 2022). However, “aggressive” doesn’t necessarily mean invasive—it means taking symptoms seriously from the start and not waiting months to implement appropriate interventions. The phases described below represent a general framework, but individual cases may progress through these stages more quickly or slowly depending on circumstances.
As Dr. Harrison Irons of Southern Ketamine & Wellness emphasizes, “Recovery takes time, and treatments may take months to show full effect. The key is developing a healthcare plan and sticking to it while maintaining patience and trust in your healthcare providers.”
Phase One: Prevention and Early Intervention (First 3-6 Months)
If you’re in the early weeks or months after your initial injury, prevention and mitigation remain possible. This phase focuses on three priorities: adequate pain control, appropriate mobilization, and careful monitoring.
Pain Management
Initial pain control typically begins with medications following the WHO analgesic ladder (Perez et al., 2010). Your doctor may prescribe:
- Non-steroidal anti-inflammatory drugs (NSAIDs) for pain and inflammation
- Neuropathic pain medications like gabapentin or pregabalin for nerve-related pain
- Tricyclic antidepressants at low doses, which can help neuropathic pain even without depression
For inflammatory symptoms specifically, some treatment protocols include free-radical scavengers or other anti-inflammatory approaches. The goal is managing pain sufficiently so you can participate in physical rehabilitation.
Physical and Occupational Therapy
Physical therapy should begin as early as safely possible. This is perhaps the most important component of early CRPS treatment, with strong evidence supporting its role (Harden et al., 2022).
Your therapy program should be tailored to CRPS and include:
- Gentle range of motion exercises
- Desensitization techniques to reduce hypersensitivity
- Graded motor imagery and mirror therapy
- Strategies to normalize movement patterns
- Gradual return to functional activities
The emphasis here is on gentle and gradual. Aggressive therapy that causes significant pain flares can actually worsen CRPS. You need a therapist experienced in CRPS who understands this delicate balance.
What to Expect in This Phase
Response to treatment during this early phase varies significantly. Some patients experience substantial improvement within weeks, while others see slower progress. If you’re not seeing improvement within 4-6 weeks of appropriate therapy and pain management, or if symptoms are worsening despite treatment, it’s time to discuss advancing to the next phase with your healthcare team.
Phase Two: Established CRPS Management (3-12 Months)
If symptoms persist beyond the first few months despite appropriate Phase One interventions, you’ve likely moved into established CRPS. This doesn’t mean treatment has failed—it means your nervous system changes require additional approaches.
Expanded Medication Options
At this stage, your physician may consider:
- Adjusting neuropathic pain medication doses or trying different medications in this class
- Adding medications that address autonomic dysfunction
- Exploring topical treatments for localized symptoms
- Evaluating whether psychological factors like anxiety are interfering with progress and addressing them appropriately
It’s worth noting that no single medication has definitive high-quality evidence for CRPS, but many can provide meaningful benefit as part of a comprehensive approach (Harden et al., 2022). The goal is finding what helps you function better.
Continued Rehabilitation with Advanced Techniques
Physical therapy remains essential, but techniques may become more sophisticated:
- Graded motor imagery programs have shown benefits in research studies
- Mirror therapy may help improve both pain and function
- Tactile discrimination training helps retrain how your brain processes sensory information
- Progressive loading exercises carefully increase what your affected limb can tolerate
These brain-based therapies specifically target the central nervous system changes that drive CRPS.
Psychological Support
Chronic pain affects mental health, and that’s not weakness—it’s biology. Many patients benefit from working with a psychologist or counselor who specializes in chronic pain. Cognitive-behavioral therapy can help you develop skills to manage the emotional aspects of living with CRPS and address fear-avoidance behaviors that may be limiting your rehabilitation progress.
Interventional Procedures
Some patients at this stage try sympathetic nerve blocks. These procedures may provide temporary relief and can help determine whether sympathetically-maintained pain is a significant component of your CRPS. Results vary considerably between individuals, and the evidence for long-term benefit is mixed (Perez et al., 2010).
What to Expect in This Phase
Many patients see gradual improvement during this phase with persistent effort. However, improvement often isn’t linear—you may have good weeks and difficult weeks. Track your overall trend over months rather than day-to-day fluctuations.
If you’ve worked diligently through appropriate Phase Two treatments for several months without adequate improvement, it may be time to discuss more advanced interventions.
Phase Three: Refractory CRPS and Advanced Interventions (12+ Months)
When CRPS persists despite comprehensive conservative treatment, you haven’t run out of options. Several advanced therapies specifically target the central nervous system changes underlying treatment-resistant CRPS.
Advanced Neuromodulation
Some patients explore:
- Spinal cord stimulation
- Dorsal root ganglion stimulation
- Other neuromodulation approaches
These require surgical implantation and work by directly modifying how pain signals are processed. Success rates vary, and they represent significant interventions requiring careful consideration.
NMDA Receptor Antagonist Therapy
Ketamine infusion therapy has emerged as an important option for treatment-resistant CRPS. Multiple research studies have demonstrated that sub-anesthetic ketamine infusions can provide significant pain relief for CRPS patients who haven’t responded to standard treatments (Tedeschi et al., 2025).
Ketamine works by blocking NMDA receptors in the brain and spinal cord—the same receptors involved in the central sensitization that drives CRPS. The typical protocol involves a series of infusions administered under medical supervision, usually in an outpatient setting.
Southern Ketamine & Wellness, with locations in Birmingham and Auburn, offers ketamine infusion therapy specifically for treatment-resistant pain conditions including CRPS. Dr. Irons’ dual board certification in anesthesiology and pain management provides the expertise necessary for safe ketamine administration. His experience at UAB and the VA hospital system caring for patients with complex pain conditions informs the personalized protocols used at the clinic.
It’s important to understand that results vary between individuals. Some patients experience substantial relief that lasts for weeks or months, while others have more modest responses. The treatment isn’t appropriate for everyone, and a thorough evaluation determines candidacy.
What to Expect in This Phase
Advanced interventions require significant commitment—both in time and often financially, as insurance coverage varies. These treatments work best as part of a comprehensive approach that continues to include physical therapy and other supports.
The goal at this stage shifts somewhat. While everyone hopes for complete pain resolution, even partial improvement that allows you to function better and reduce reliance on daily pain medications represents meaningful success.
Timeline Considerations for Alabama Residents
Access to specialized CRPS treatment has historically been limited in Alabama, which sometimes means patients progress through treatment phases more slowly than ideal. The availability of ketamine infusion therapy in Birmingham and Auburn provides Alabama residents with local access to advanced treatment without traveling out of state.
Early consultation, even if you’re still in Phase One or Two, can be valuable. Understanding what options exist if current treatments don’t provide adequate relief helps with treatment planning and reduces anxiety about “running out of options.”
Factors That Influence Your Timeline
Several factors affect how quickly you progress through treatment phases:
Time since onset: Symptoms present for less than one year typically respond better across all treatment types (Tedeschi et al., 2025). This doesn’t mean later treatment won’t help, but it emphasizes the importance of not delaying appropriate care.
Age and overall health: Younger patients and those in good general health often have better outcomes. However, people of all ages can experience meaningful improvement with appropriate treatment.
Consistency with rehabilitation: Patients who maintain consistent participation in physical therapy, even when progress feels slow, generally do better than those who stop and start.
Addressing all components: CRPS affects you physically, mentally, and socially. Patients who address all these dimensions typically see better outcomes than those focusing on just one aspect.
Three Steps You Can Take This Week
- Request a comprehensive evaluation if you haven’t had one recently. CRPS treatment should be regularly reassessed. If you’ve been on the same treatment plan for months without improvement, schedule a follow-up to discuss next steps.
- Research your treatment options for your current phase. Understanding what typically comes next helps you ask informed questions and make decisions aligned with your goals. If you’re approaching the 6-12 month mark without adequate relief, start learning about advanced options.
- Consider scheduling a consultation with a specialist. For Birmingham and Auburn area residents, Southern Ketamine & Wellness offers consultations to discuss whether advanced treatment options might be appropriate. Even if you’re not ready for treatment now, having information helps with future planning.
Making Informed Decisions
Every treatment decision involves weighing potential benefits against risks, time commitment, and costs. No treatment guarantees specific results, and what works well for one CRPS patient may work differently for another.
The most important thing is having a healthcare team experienced in CRPS who can guide you through these phases and help you make decisions that make sense for your individual situation. Don’t hesitate to seek additional opinions, ask questions, or advocate for advancing to the next treatment phase if your current approach isn’t providing adequate relief.
CRPS treatment has come a long way in recent years. While the journey can be challenging, many patients do find meaningful relief and are able to reclaim significant function and quality of life. Understanding the treatment timeline helps you stay hopeful and engaged as you work toward that goal.
References
Harden, R.N., McCabe, C.S., Goebel, A., Massey, M., Suvar, T., Grieve, S., & Bruehl, S. (2022). Complex Regional Pain Syndrome: Practical Diagnostic and Treatment Guidelines, 5th Edition. Pain Medicine, 23(Supplement 1), S1-S53. https://academic.oup.com/painmedicine/article/23/Supplement_1/S1/6605306
Perez, R.S.G.M., Zollinger, P.E., Dijkstra, P.U., Thomassen-Hilgersom, I.L., Zuurmond, W.W.A., Rosenbrand, K.C.J.M., & Geertzen, J.H.B. (2010). Evidence based guidelines for complex regional pain syndrome type 1. BMC Neurology, 10, 20. https://pmc.ncbi.nlm.nih.gov/articles/PMC2861029/
Tedeschi, R., Giorgi, F., Platano, D., & Berti, L. (2025). Current and Evolving Concepts in the Management of Complex Regional Pain Syndrome: A Narrative Review. Diagnostics, 15(3), 353. https://www.mdpi.com/2075-4418/15/3/353
