Complex regional pain syndrome is one of the most painful and least understood conditions in clinical medicine — and one of the most frequently misdiagnosed, with patients waiting years on average before receiving an accurate diagnosis. At Revitalize Ketamine Clinic in Flagstaff, our medical director Jill Dubravcic treats CRPS directly, and we find that patients who understand the distinction between Type 1 and Type 2 arrive far better equipped to advocate for appropriate care. The difference is not academic — it shapes how the condition is diagnosed, how it is explained, and how treatment is structured.
What CRPS Actually Is
Complex regional pain syndrome — CRPS — is a chronic pain condition characterized by severe, disproportionate pain that typically affects one limb and is accompanied by changes in skin color, temperature, swelling, and in many cases, altered movement and sensitivity in the affected area (Mayo Clinic). The pain is described by patients as burning, stabbing, or electric, and it tends to be dramatically out of proportion to any tissue injury that precipitated it. That disproportionality is one of the defining clinical features — the nervous system’s response to injury or stress has, in effect, become the injury.
CRPS most commonly develops after a trauma — a fracture, a surgery, an immobilization — though in some cases it emerges after an illness or even without a clear precipitating event. The condition involves dysfunction in the peripheral and central nervous systems, including sensitization of pain-processing pathways and dysregulation of the inflammatory and autonomic systems. This neurological basis is directly relevant to why certain treatments — including ketamine infusions — may reach the underlying mechanism in a way that conventional pain medications often cannot.
Type 1 vs Type 2: Where the Distinction Lies
The difference between CRPS Type 1 and Type 2 comes down to one factor: whether a specific nerve injury has been confirmed.
CRPS Type 1 — formerly called reflex sympathetic dystrophy, or RSD — occurs without a confirmed nerve lesion. The pain and associated symptoms arise after an injury or triggering event, but no identifiable nerve damage can be documented. This is by far the more common presentation, accounting for the majority of CRPS diagnoses. The absence of a confirmed nerve lesion does not mean the condition is less severe or less real — it means the nervous system dysfunction is diffuse rather than localized to a specific damaged nerve.
CRPS Type 2 — formerly called causalgia — is distinguished by a confirmed injury to a specific peripheral nerve. The pain distribution often follows the pattern of that nerve’s territory, though it can spread beyond it. The confirmed nerve lesion gives clinicians a more defined anatomical target, but the downstream sensitization and autonomic dysregulation can be as complex and difficult to treat as Type 1 (Mayo Clinic).
Clinically, both types share the same core diagnostic criteria: persistent pain disproportionate to any inciting event, evidence of sensory, vasomotor, sudomotor, or motor and trophic abnormalities, and the absence of another diagnosis that better accounts for the symptoms. The distinction between Type 1 and Type 2 matters for documentation and for understanding the source of nerve dysfunction — but both types are treated within the same clinical framework at Revitalize, and both may respond to ketamine infusion therapy.
Why CRPS Is So Difficult to Treat Conventionally
Standard pain management approaches — NSAIDs, opioids, anticonvulsants, physical therapy — produce inconsistent results in CRPS because they address pain signaling downstream rather than the central sensitization that drives it. Central sensitization refers to the process by which the central nervous system becomes amplified in its response to pain signals, effectively lowering the threshold at which stimuli are experienced as painful and sustaining pain independently of ongoing tissue injury.
Research documents the strong bidirectional relationship between chronic pain and depression, with each condition worsening the other (National Institutes of Health). This is particularly relevant for CRPS patients, whose quality of life and mental health are frequently severely impacted by years of undertreated or poorly treated pain. The psychological burden of CRPS — the depression, the anxiety, the social withdrawal — is not separate from the pain condition. It is part of it, and an effective treatment approach needs to address both dimensions.
How Ketamine Addresses the CRPS Mechanism
Ketamine’s mechanism of action is directly relevant to central sensitization. By blocking NMDA receptors — proteins that regulate glutamate, the brain’s primary excitatory neurotransmitter — ketamine interrupts the amplified pain signaling cycle that characterizes sensitized pain states (National Institutes of Health). This is not a general analgesic effect. It is a targeted disruption of the neurological process that makes CRPS pain so persistent and so disproportionate to the original injury.
Clinical evidence supports ketamine’s effectiveness in treating chronic pain conditions through precisely this NMDA receptor action (National Institutes of Health). For CRPS patients specifically, the goal of ketamine infusion therapy is not simply to mask pain but to interrupt the central sensitization cycle — creating a window in which the nervous system may recalibrate and in which other rehabilitation interventions, including physical therapy and psychological support, can take hold more effectively.
At Revitalize, Jill Dubravcic serves as our medical director with specific expertise in treating CRPS, fibromyalgia, chronic pain, neuropathic pain, and related conditions. Patients with CRPS undergo the same comprehensive intake process as our psychiatric patients — a full medical history review, medication reconciliation, and assessment of whether ketamine infusion therapy is clinically appropriate for their specific presentation. Not every patient with CRPS is a candidate for ketamine, and we are direct about that during the evaluation process.
The Depression-Pain Connection in CRPS Patients
The relationship between chronic pain and depression is not incidental. Research confirms that each condition worsens the other in ways that create a reinforcing cycle: pain disrupts sleep, limits function, and erodes the sense of agency and hope that makes it possible to engage with treatment (National Institutes of Health). For CRPS patients, who often carry years of diagnostic delay and treatment failure before reaching us, that psychological dimension is frequently as debilitating as the pain itself.
This is part of why our approach at Revitalize addresses the full patient, not just the pain signal. Cilla Pennington, our licensed integration therapist, works with patients — including those with chronic pain — using trauma-informed care and evidence-based therapeutic approaches. The neuroplasticity that ketamine infusions may promote creates an opportunity for therapeutic work that extends beyond pain management into the quality-of-life and psychological dimensions that chronic pain conditions consistently compromise. Results vary by individual, and we do not promise a specific pain reduction outcome from any treatment course. What we offer is a rigorous evaluation, clinical expertise in this condition, and a treatment model that addresses the condition holistically.
Addressing the Barriers: Cost and Finding Qualified Care
Two barriers come up consistently for CRPS patients in Northern Arizona. The first is cost. IV ketamine at Revitalize is self-pay: the intake session is $625, infusions two through six are $525 each, and maintenance sessions are $425. This is a meaningful expense, and we acknowledge it directly. Patients who want to explore their options are encouraged to contact us for a consultation — we will discuss your specific situation, what a realistic treatment course might look like, and what the financial commitment actually involves before you make any decisions.
The second barrier is access to qualified care. CRPS is a condition where specialty expertise matters considerably, and in Northern Arizona, options are limited. Revitalize serves patients from across the region — including patients who have traveled from outside Flagstaff specifically for CRPS treatment. Our Flagstaff, Sedona, and Prescott Valley locations make that access more practical for patients from different parts of Northern Arizona, and our at-home ketamine option is available as a maintenance pathway for patients who qualify after completing an initial in-clinic series. Discuss your situation with your provider to determine whether you are a candidate.
Frequently Asked Questions
How is CRPS diagnosed? CRPS is diagnosed clinically based on symptom criteria — there is no definitive blood test or imaging study that confirms it. Clinicians use the Budapest Criteria, which require the presence of ongoing pain disproportionate to any inciting event, along with specific categories of reported and observed symptoms including sensory changes, skin color or temperature changes, swelling, and motor or trophic changes. The distinction between Type 1 and Type 2 is established by whether a specific nerve injury can be confirmed through clinical exam or electrodiagnostic testing.
Does ketamine work differently for CRPS Type 1 vs Type 2? The mechanism — NMDA receptor blockade interrupting central sensitization — is the same regardless of CRPS type. Both Type 1 and Type 2 involve central sensitization as a core feature of their pain chronicity, which is why ketamine’s mechanism is relevant to both. Whether a specific patient is a good candidate depends on their full clinical picture, not their type designation alone. This is a conversation to have during your evaluation at Revitalize.
Can ketamine be used alongside other CRPS treatments? Yes, and in many cases it is used as part of a broader treatment plan that may include physical therapy, psychological support, and medication management. Ketamine infusions are not a replacement for comprehensive rehabilitation — they are a tool that may make other interventions more accessible by reducing the pain burden. At Revitalize, we work with existing providers and encourage ongoing collaboration with your full care team throughout treatment.
How many ketamine infusions does CRPS typically require? A standard induction series at Revitalize involves six infusions. The response to CRPS can vary — some patients experience meaningful relief within the series, while others may require maintenance infusions on an ongoing basis. We monitor your response throughout the series and discuss next steps based on what we observe. Results vary by individual, and we will give you an honest assessment at each stage rather than a predetermined protocol.
Is CRPS related to depression, or are they separate conditions? They are separate conditions that frequently co-occur. Research is clear that chronic pain and depression worsen each other through overlapping neurological and psychological mechanisms. For patients who present with both CRPS and depression or anxiety, we evaluate each dimension during intake and consider treatment options that may address both — including whether IV ketamine’s antidepressant properties are relevant alongside its pain management application. Explore your full clinical picture with your provider.
Key Takeaways
- CRPS Type 1 occurs without a confirmed nerve lesion; CRPS Type 2 is distinguished by a documented injury to a specific peripheral nerve — both share the same core diagnostic criteria and treatment framework.
- Central sensitization — the nervous system’s amplified, self-sustaining pain response — is the mechanism that makes CRPS so resistant to conventional pain management and the primary target of ketamine’s NMDA receptor-blocking action.
- Clinical evidence supports ketamine’s effectiveness for chronic pain conditions through its action on NMDA receptors, which directly addresses the central sensitization driving CRPS pain.
- Chronic pain and depression have a strongly documented bidirectional relationship; an effective treatment approach addresses both dimensions, not pain in isolation.
- Results vary by individual; a comprehensive clinical evaluation with a provider experienced in CRPS — including full medical history, medication review, and candidacy assessment — is the required first step before any treatment begins.
If you have CRPS — Type 1 or Type 2 — and have not found adequate relief through conventional pain management, we want to hear your full history. Call Revitalize Ketamine Clinic at 928-589-0567 in Flagstaff, 928-493-8222 in Prescott Valley, or 928-325-2323 in Sedona, or request a consultation through our website. Our medical director Jill Dubravcic treats CRPS directly, and we will give you an honest assessment of whether ketamine infusion therapy is appropriate for your situation.
References
Complex Regional Pain Syndrome. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/crps-complex-regional-pain-syndrome/symptoms-causes/syc-20371151
Ketamine for Chronic Pain. National Institutes of Health. https://www.ncbi.nlm.nih.gov/books/NBK539824/
Depression and Pain. National Institutes of Health. https://pmc.ncbi.nlm.nih.gov/articles/PMC5494581/
NMDA Receptor / Glutamate System. National Institutes of Health. https://pmc.ncbi.nlm.nih.gov/articles/PMC5148235/
Medical Disclaimer
The information in this blog is for educational purposes only and does not constitute medical advice. Ketamine therapy for chronic pain and CRPS should only be pursued under the supervision of a licensed provider familiar with your full medical history. Individual results vary. If you are experiencing a mental health crisis or thoughts of self-harm, please call or text 988 to reach the Suicide and Crisis Lifeline or go to your nearest emergency room.