Complex Regional Pain Syndrome (CRPS) Type 1 vs Type 2: Tailoring the Treatment
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Published in The Ospina Orthopedic Blog ~ 8 min read ~ Last Updated: January 20, 2026
Deciphering the Diagnosis: The "Forest Fire" of Pain
Complex Regional Pain Syndrome (CRPS) is widely regarded as one of the most challenging and distressing conditions in pain medicine. Often described by patients as a "forest fire" raging in the nervous system, it is characterized by symptoms that seem disproportionate to any inciting event: intense burning pain, dramatic swelling, changes in skin color and temperature, and even alterations in nail and hair growth.
However, "CRPS" is an umbrella term. For informed patients and specialists alike, distinguishing between Type 1 and Type 2 is not an academic exercise; it is the cornerstone of an effective treatment strategy. At Ospina Medical, we utilize the "Budapest Criteria" to strictly define the diagnosis and tailor our approach accordingly.
- CRPS Type 1 (formerly Reflex Sympathetic Dystrophy / RSD): This subtype accounts for approximately 90% of cases. It develops after an initiating noxious event—such as a fracture, sprain, or crush injury—but without a verifiable nerve lesion. The pathology is primarily driven by central sensitization (the brain and spinal cord amplifying signals) and sympathetic nervous system dysregulation.
- CRPS Type 2 (formerly Causalgia): This subtype is defined by the presence of a distinct, confirmed nerve injury. There is a specific peripheral nerve (e.g., the median nerve after carpal tunnel surgery, or the peroneal nerve after a knee injury) that has been damaged and is acting as a persistent generator of neuropathic pain.
Tailored Treatments for Distinct Types
Because the underlying drivers differ, a one-size-fits-all approach—typically relying on generalized sympathetic blocks or medication—often fails. At Ospina Medical, we match the mechanism of treatment to the mechanism of the disease.
For CRPS Type 1: Modulating the Central System
Since Type 1 is driven by central sensitization and sympathetic overdrive, the goal is to "reset" or mask the faulty signaling at the level of the spinal cord.
- Dorsal Root Ganglion (DRG) Stimulation: This is a revolutionary advancement for focal CRPS (e.g., pain isolated to the foot or knee). Unlike traditional Spinal Cord Stimulation (SCS) which stimulates the dorsal columns, DRG stimulation targets the specific cluster of nerve cell bodies (the dorsal root ganglion) that act as the primary "gatekeeper" for sensory information from a specific body part. Evidence from the ACCURATE trial has shown DRG stimulation to be superior to traditional SCS for CRPS, providing more precise management with less paresthesia (tingling).
- Spinal Cord Stimulation (SCS): For more widespread symptoms, high-frequency SCS can effectively dampen the hyperexcitability of the dorsal horn, reducing the perception of pain and the associated sympathetic symptoms.
For CRPS Type 2: Regenerative Nerve Hydrodissection
In Type 2, there is a specific anatomical target: the injured nerve. This allows us to utilize Regenerative Medicine to treat the pathology at its source. We employ a technique called Nerve Hydrodissection using Platelet Lysate.
- The Procedure: Using high-frequency ultrasound, Dr. Kohler visualizes the damaged nerve, which often appears swollen or entrapped in scar tissue. A needle is carefully guided adjacent to the nerve (never inside it).
- The Mechanism: Fluid is injected to mechanically separate the nerve from the surrounding fascia and scar tissue. This "hydrodissection" releases the physical compression, improving blood flow (vasa nervorum) and axoplasmic transport within the nerve.
- The Biologic Advantage: We do not just use saline. We use Platelet Lysate. As discussed in our previous articles, Platelet Lysate is rich in neurotrophic factors like VEGF and NGF. Injecting this biologic bath around the nerve helps to downregulate inflammation, promote remyelination, and support the repair of the damaged nerve tissue. This approach offers a potential for improvement that blocks and steroids cannot match.
The Ospina Approach: Precision and Empathy
We recognize that CRPS patients frequently suffer from a lack of validation, having been told their pain is "psychological" or "inoperable." At Ospina Medical, we recognize the biological severity of your condition. Whether connecting you to cutting-edge neuromodulation to calm a sensitized central nervous system or delivering precise orthobiologics to heal a damaged peripheral nerve, our goal is to turn down the volume on your pain and restore your quality of life.
Conclusion
CRPS is a formidable opponent, but it is not invincible. By accurately classifying your condition as Type 1 or Type 2 and applying targeted, evidence-based interventions, we can offer hope and tangible results where others offer only management.
If you are battling CRPS, schedule a consultation with Dr. Matthew Kohler to explore advanced, targeted treatment options tailored to your specific diagnosis.
A Riley Publication ~ Branded Thought Leadership by Riley Partners and Publications, Inc.
Medically Reviewed by: Matthew Kohler, MD