Can Lyme Disease Trigger CRPS?
Severe pain may not be “just CRPS”
Infection can drive nerve symptoms
Lyme is often not considered
Some cases may be reversible
The connection between Lyme disease and CRPS highlights a critical but often missed cause of severe nerve pain. In rare cases, what appears to be complex regional pain syndrome (CRPS) may actually be driven by underlying infection.
A landmark case described a patient with severe limb pain diagnosed as CRPS—until testing revealed active Lyme disease. After antibiotic treatment, both the infection and the pain resolved.
This case challenges the assumption that CRPS is always a primary pain disorder.
Understanding the Lyme Disease and CRPS Connection
CRPS (formerly reflex sympathetic dystrophy) is a chronic pain condition involving abnormal nerve signaling and autonomic dysfunction.
In Lyme disease, Borrelia burgdorferi may:
- Invade peripheral nerves
- Trigger inflammation
- Alter immune responses
- Disrupt autonomic nervous system regulation
These mechanisms can produce CRPS-like symptoms—or contribute directly to the condition.
The connection is often missed because CRPS evaluations rarely include screening for tick-borne illness.
What CRPS Feels Like
Patients with CRPS often describe:
- Burning, severe pain out of proportion to exam findings
- Pain from light touch (allodynia)
- Swelling or stiffness
- Skin color or temperature changes
- Weakness or reduced mobility
These symptoms overlap with:
- Lyme neuropathy
- autonomic dysfunction
- CRPS dysautonomia
This overlap is one reason Lyme disease may be overlooked in patients diagnosed with CRPS.
When to Suspect Lyme Disease in CRPS
Clinicians should consider Lyme disease when:
- Pain is severe but difficult to explain structurally
- Symptoms began after possible tick exposure
- Standard CRPS treatments fail
- Neurologic or systemic symptoms are also present
Unexplained, treatment-resistant pain should prompt reconsideration of underlying causes.
For broader symptom context, see Lyme disease symptoms.
Why the Lyme Disease CRPS Connection Is Missed
The connection between Lyme disease, CRPS, and autonomic dysfunction is underrecognized because:
- CRPS is usually managed by pain specialists
- Infectious causes are not routinely evaluated
- Lyme disease may not be considered outside endemic regions
- Dysautonomia symptoms may be attributed solely to CRPS
This can delay diagnosis and prolong suffering.
Clinical Implications
The reported case demonstrated complete resolution of CRPS after antibiotic treatment for Lyme disease.
This suggests that some CRPS cases may be infection-related—and potentially reversible.
Early recognition may prevent long-term nerve sensitization, autonomic dysfunction, and disability.
Clinical Takeaway
The connection between Lyme disease and CRPS highlights an important diagnostic opportunity.
Infection-driven nerve inflammation can mimic—or cause—CRPS and dysautonomia.
When pain is severe, unexplained, or treatment-resistant, Lyme disease should be considered.
Frequently Asked Questions
Can Lyme disease trigger CRPS?
Yes. Infection can trigger nerve inflammation and autonomic dysfunction that produce CRPS-like symptoms.
Can CRPS from Lyme disease be reversed?
In some cases, yes—particularly when the underlying infection is identified and treated.
Is CRPS considered an autonomic disorder?
CRPS involves dysfunction of the autonomic nervous system and may overlap with dysautonomia symptoms.
Why isn’t Lyme disease routinely checked in CRPS?
CRPS evaluations typically focus on neurologic and pain mechanisms rather than infectious triggers.
Related Reading
- Chronic pain in Lyme disease
- Burning pain with normal EMG
- Allodynia explained
- Lyme neuropathy
- Autonomic dysfunction
References
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
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/