A man in Slovenia developed unexplained, severe limb pain that wouldn’t respond to standard treatment. X-rays and scans pointed to Complex Regional Pain Syndrome (CRPS), yet blood tests revealed active Lyme disease. When doctors treated the infection, both conditions completely resolved.
This landmark 2002 case, published in Infection by Šibanc and colleagues, was one of the first to reveal the Lyme disease CRPS connection — and to show that treating infection could reverse what appeared to be intractable nerve pain.
Understanding the Lyme Disease CRPS Connection
Although rare, CRPS (formerly Reflex Sympathetic Dystrophy) can appear after infection, including Lyme disease. Type I involves pain without documented nerve damage, while Type II involves documented nerve injury.
Borrelia burgdorferi, the bacterium that causes Lyme disease, can invade peripheral nerves, triggering inflammation or immune responses that mimic — or directly cause — CRPS. The Lyme disease CRPS connection is underrecognized because clinicians evaluating CRPS rarely screen for tick-borne infection.
What CRPS Feels Like
Patients describe burning, disproportionate pain, sometimes so severe that even light touch hurts — a phenomenon known as allodynia. The affected limb may be swollen, pale, or mottled, with temperature shifts, stiffness, and weakness. Over time, the nervous system becomes hypersensitive, limiting movement and quality of life.
These features overlap significantly with Lyme neuropathy and autonomic dysfunction — which is part of why the connection between the two conditions is so frequently missed.
When to Suspect CRPS After Lyme Disease
After Lyme infection, pain that defies exam findings should raise suspicion. Patients may experience burning or throbbing pain, swelling, color changes, or temperature differences between limbs. When these symptoms persist despite standard treatment, clinicians should consider CRPS early.
In my clinical practice, I’ve seen patients develop CRPS-like pain after Lyme disease — cases where standard pain therapies failed until infection and inflammation were directly addressed. Early recognition and multidisciplinary care can prevent chronic nerve sensitization and long-term disability.
Clinical Perspective
The Lyme disease CRPS connection shows how infection-driven nerve inflammation can masquerade as chronic pain. The Šibanc case reminds us that some CRPS cases may be infection-related and reversible.
If you experience unexplained limb pain after Lyme disease — particularly with swelling, skin color changes, or temperature asymmetry — the possibility of a Lyme disease CRPS connection deserves investigation. Treating the underlying infection-driven pain rather than suppressing symptoms alone can prevent progression to permanent disability.
Frequently Asked Questions
Can Lyme disease cause CRPS?
Yes. Borrelia burgdorferi can invade peripheral nerves, triggering inflammation that produces CRPS-like pain including burning, swelling, and skin changes in affected limbs.
Can CRPS from Lyme disease be reversed?
In some cases, yes. The Šibanc case demonstrated complete resolution of CRPS after the underlying Lyme infection was treated with antibiotics.
How is CRPS different from Lyme neuropathy?
CRPS involves regional pain with autonomic features like swelling, color changes, and temperature asymmetry. Lyme neuropathy is broader and may include burning pain, numbness, or tingling without the localized autonomic signs characteristic of CRPS. The two can overlap.
Why isn’t Lyme disease routinely checked in CRPS patients?
CRPS is typically evaluated by pain specialists or neurologists who may not consider infectious causes. Lyme disease is rarely included in the standard CRPS workup, particularly outside endemic areas.
What should I do if I have CRPS-like symptoms after Lyme disease?
Seek evaluation from a clinician experienced in both Lyme disease and neuropathic pain. If an underlying infection is contributing, treating it may improve or resolve symptoms that standard pain management alone cannot address.
References
- Šibanc B, Lesničar G, Ružić-Sabljić E, Lotrič-Furlan S. Complex regional pain syndrome and Lyme borreliosis: two different diseases? Infection. 2002;30(6):396–399.
Related Reading
- Lyme Disease Pain: Why It Moves and What Helps
- Allodynia: When Normal Touch Becomes Painful
- Burning Pain With Normal EMG: Understanding the Disconnect
- Lyme Disease Neuropathy: Symptoms and What Causes It
- Autonomic Dysfunction in Lyme Disease
- Could Autonomic Dysfunction Lead to Pain in Lyme Disease?
- Medical Dismissal and Lyme Disease
Hello Dr Cameron,
I had undiagnosed Lyme for 7 years. I was bitten in 1992 but thought it was a spider bite. I kept a diary of symptoms and three months later I saw an Internal Medicine MD. He tested me for everything except Lyme.
My first symptom was brain related. I couldn’t balance my simple business checking account. My job before that was Payroll Manager for a large oil company and all of their convenient stores in GA and FL.
My symptoms included brain fog, ADHD, Panic Attacks and I felt like I had Dylexia as I was teaching at my massage school and started writing letters backwards and suddenly had trouble spelling. Before Lyme I had a photographic memory and won spelling bees in school.
I would be driving and get to an intersection that I no longer recognized. I would easily get lost.
Once my husband and I went to lunch at a buffet restaurant. After getting my food I got lost for a few minutes and could not remember how to get back to our table.
After a few months I started having pain all over my body. The pain would move from knees, shoulders, hips, etc. Eventually I had unexplained pain over most of my body with burning pain in my mid to upper back. This was especially bad if I over worked my body.
If I got too many massages, which would happen when testing our students, I would go into severe flu like symptoms and all over pain.
I learned if I went to a gym after this and detoxed using the sauna, hot tub and steam room, the symptoms were much less.
I was disabled for about 7 years with all of these symptoms. I was referred to a rhumatologist who pretty much dismissed my symptoms. I would often cry in his office. My knees hurt so bad but xrays showed my joints were good.
He did recommend massage which I got weekly. I know this helped me keep working.
He told me that my inflammation was so high that I would most likely get Lupus. I asked if he could help me prevent Lupus. He said he would treat me early to slow the symptoms. I never went back to him.
I started taking Juice Plus (fruits and veggies vine ripeed, juiced, dried at a low tempature and put in capsules and changed my diet. I went to Herb School and learned about cleansing all the systems of my body.
I cleansed and norurished for 2 years and I started feeling normal again.
I finally found an Infectious Disease MD in Atlanta who treats Lyme.
Testing showed I had high antibodies for Lyme but not an active infection.
I feel like I have overcome at least 95% of Lyme symptoms and live a fairly active life now at age 73.
I was a 41 year old high energy woman when I got Lyme. I continue to do everything I can to improve my health and am so thankful to have overcome this debilitaing disease.
Sadie McElroy
I am glad you came so far
Dr Cameron, I was in a car accident in 2009, My leg bone broke through my pelvis and damage my sciatic nerve (now have drop foot) I developed what was identified by a neurologist with (Reflex Sympathy Disorder) I believe the term used prior to CRPS. I believed all of my pain and insomnia were associated with the CRPS. Over the years sleep, & Pain were constant and worsening. I developed neck pain, became angry and aggressive and had significant stomach issues. I became extremely sensitive to the cold, and I dropped a great deal of weight. My thyroid check revealed that, what was once was a slow thyroid (took synthroid for years prior) had sped up and this is what I believed was the culprit of the majority of my symptoms.
It was suggested by a peer I see a Lyme specialist (not covered by HMO?) which of course revealed Lyme. Doxy was prescribed and over time my symptoms abided and things were better. I have had to stop seeing the Lyme Specialist as I cant afford the out of pocket expense. I would like to have my primary manage the on and off antibiotics. I was hoping you could point me in a direction that I could then pass along to my primary so that he would feel more comfortable with the treatment? Sorry for the long story, only to get to a short point but I didn’t want to think I was a crack pot wasting your time.
It hope your primary work out. I share what have learned in practice and share in my blog series. Here is a blog discussing Lyme and a concussion https://danielcameronmd.com/post-concussion-syndrome-symptoms-due-to-lyme-disease/