Every illness, disease, or medical condition has what we call a natural history. The natural history describes what typically happens for that patient with a particular problem. Natural history may include how quickly the disease advances or progresses. It also includes what signs and symptoms develop at each stage. Prognosis and what to expect at different time points of disease are also part of the natural history.

The natural history of complex regional pain syndrome (CRPS) is not usually one of complete recovery or cure. Research shows that CRPS comes with a wide range of symptoms that are present early on (during the first five years) and tend to get worse over time.

There are some things that can help improve symptoms. For example, many patients benefit from medications, rest, and warm temperatures (e.g., hot weather, hot or warm water). Massage, elevation of the limb, and physical therapy are also helpful for some patients. Avoiding aggravating factors (that is to say, things that could be counted on to make the symptoms worse) is the other side of the coin.

Aggravating factors include cold, physical activity, and some specific motions. Standing still too long, holding the arms up overhead, being in a car (as driver or passenger) for a long time, and stress are reported by patients as contributing to more intense pain.

Management of symptoms is really the key to treatment. By helping alleviate pain, muscle spasm, and weakness, patients can become more functional with fewer limitations in their everyday activities or work life. Scientists hope for a cure but we don't have one yet.

Robert J. Schwartzman, MD, et al. The Natural History of Complex Regional Pain Syndrome. In Clinical Journal of Pain. May 2009. Vol. 25. No. 4. Pp. 273-280.

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