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Complex Regional Pain Syndrome (CRPS) is a chronic pain condition that typically affects one limb and is often triggered by injuries, surgeries, strokes, or heart attacks. Its physical ramifications can completely alter a person’s lifestyle, and the legal aspects of the condition can add to the burden.
This article aims to provide you with a comprehensive understanding of CRPS, equipping you with the knowledge to navigate your rights and be informed about your legal options.
One of the challenges of CRPS is that its diagnosis is somewhat subjective. This creates difficulties in obtaining sufficient appropriate compensation for personal injury and workers’ compensation claims. It was formerly known as RSD (reflex sympathetic dystrophy) or causalgia and is occasionally mistakenly referred to as “Chronic Regional Pain Syndrome.”
Doctors classify CRPS as Type I or II.
In Type II, there is known damage to a nerve. For instance, if a nerve is cut during surgery and CRPS develops. In Type I, there is no documented nerve injury, but there is often some trauma or fracture, although the trauma can be relatively minor.
The Elusive Nature of CRPS
Due to its somewhat subjective nature, diagnosing CRPS can be complex. Doctors rely on patients’ verbal symptoms and physicians’ physical observations. As there is no definitive diagnostic test for the condition, doctors rely on clinical history and physical exams for diagnosis. It is a diagnosis of exclusion.
Unfortunately, this lack of diagnostic confirmation makes proving the severity of the condition demanding, as insurance adjusters and jurors tend to be skeptical of conditions they cannot “touch, feel, or see.”
In such cases, it is crucial to have an experienced personal injury lawyer with in-depth knowledge of CRPS who can gather potent medical evidence and build a compelling case to challenge the insurer’s stance.
What Causes CRPS?
Although the exact cause of Complex Regional Pain Syndrome (CRPS) is not fully understood, it is thought to be related to a central or peripheral nervous system malfunction that can cause various symptoms that can vary from person to person. CRPS is believed to be triggered by an injury or trauma to the affected limb, such as a fracture, sprain, surgery, or even a minor injury.
In some cases, CRPS may occur without apparent injury or known cause. Researchers believe the condition may be caused by a combination of factors, including immune system abnormalities, blood flow changes, and abnormal nerve signaling.
CRPS primarily affects one limb but can also spread to other parts of the body. The condition is characterized by severe pain, swelling, and changes in the skin.
The Most Common Symptoms of CRPS Include:
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PHOTO ©2024 Maynard Law: Actual Client – CRPS in Left Hand with swelling, skin color changes, “shiny” skin, and hair loss on back of hand.
If you are experiencing any of these symptoms, it is essential to seek medical attention.
Early diagnosis and treatment can help manage the symptoms and prevent the condition from worsening.
How Is Complex Regional Pain Syndrome Diagnosed?
Diagnosis of CRPS is based on the “Budapest Criteria”
To make the clinical diagnosis, the following criteria must be met:
- Continuing pain, which is disproportionate to any inciting event.
- Must report at least one symptom in all four of the following categories:
- Sensory – reports of hyperesthesia and/or allodynia ("pain due to a stimulus that does not normally provoke pain.").
- Vasomotor – reports of temperature asymmetry and/or skin color changes and/or skin color asymmetry.
- Sudomotor/oedema – reports of oedema (swelling) and/or sweating changes and/or sweating asymmetry.
- Motor/trophic – reports of decreased range of motion and/or motor dysfunction (weakness, tremor, dystonia) and/or trophic changes (hair, nail, skin).
- Must display at least one sign at time of evaluation in two or more of the following categories:
- Sensory – evidence of hyperalgesia (to pinprick) and/or allodynia (to light touch and/or temperature sensation and/or deep somatic pressure and/or joint movement).
- Vasomotor – evidence of temperature asymmetry (> 1 °C) and/or skin color changes and/or asymmetry.
- Sudomotor/oedema – evidence of oedema (swelling) and/or sweating changes and/or sweating asymmetry.
- Motor/trophic – evidence of decreased range of motion and/or motor dysfunction (weakness, tremor, dystonia) and/or trophic changes (hair, nail, skin).
- There is no other diagnosis that better explains the signs and symptoms. The symptoms provide an objective basis for diagnosis of CRPS.
What Are the Treatments for CRPS?
The treatment of CRPS typically involves a multidisciplinary approach, which means multiple healthcare professionals may be involved in the treatment plan. This is because the condition can affect different body parts, and its symptoms can vary from person to person.
Treatment aims to manage pain, improve mobility, and prevent complications.
There are several different treatment options available for CRPS, including:
- Physical therapy: This type of therapy involves exercises and techniques that help to desensitize the affected area, improve mobility, and reduce pain.
- Medications: NSAIDs, opioid pain medications, and medications used to treat "nerve pain," such as Gabapentin and Lyrica, as well as antidepressants such as Nortriptyline and topical pain medicines such as Lidocaine, are commonly used.
- Psychotherapy: This type of therapy can help individuals manage the emotional and psychological aspects of living with chronic pain.
- Spinal Sympathetic Blocks/Injections: This type of treatment involves injecting medication as close to the target nerve to help reduce pain and inflammation.
- Spinal cord stimulator: This device is implanted under the skin. The electrodes are placed into the spinal canal. It sends electrical impulses to the nerves in the spinal cord to help reduce pain.
It is essential to work with a healthcare professional to develop an individualized treatment plan that addresses your specific needs and symptoms.
What Is the Life Expectancy for Someone With CRPS?
While CRPS is not considered a terminal illness, the condition can be severely debilitating and cause significant pain and disability. The prognosis for CRPS can vary widely depending on several factors, including:
- Severity of the condition.
- Patient’s age and overall health.
- Effectiveness of the treatment.
Therefore, seeking medical attention and obtaining an accurate diagnosis is crucial to begin appropriate treatment and managing the condition.
With proper care and management, many individuals with CRPS can lead fulfilling lives and manage their symptoms effectively.
Is CRPS a Lifelong Condition?
Complex Regional Pain Syndrome (CRPS) can become more aggressive over time, and it may continue to worsen progressively. Generally, our clients with CRPS have it before they retain legal services.
Unfortunately, CRPS frequently becomes or already is a permanent problem.
Severe CRPS may result in the need for home modifications and attendant care. If one has CRPS in their right hand and the condition “jumps” to the left hand (“mirror pain”), the person may need help with numerous activities of daily living daily activities (ADLs).
If the condition is especially severe, the patient may need constant attendant care 24 hours a day, seven days a week. In some patients, being touched by a sheet, light feather, or drop of water may cause extreme pain.
Even a slight breeze can cause pain in the affected extremity. If the condition affects the foot, the person may not be able to wear a sock or specific shoe.
Attendant Care
Often this “attendant care” is provided by a spouse, significant other or family member. Attendant care provided by health care agencies is extremely expensive.
The national average for 2023 for a home health aide is $33.00 per hour which is $289,000 a year for care 24 hours a day / 7 days per week.
If it is a North Carolina workers’ compensation case, the insurance carrier can be made to pay money for attendant care to the injured worker or the person providing the care.
Functional Capacity Evaluations (FCE) and CRPS
Doctors and insurers often use Functional Capacity Evaluations (FCE) to determine a person’s restrictions in workers’ compensation cases. However, an FCE is a physical examination done by a physical therapist over several hours.
It may not provide an accurate picture of what a person can do in an eight-hour day. It is important to have the CRPS doctor truly address what a patient can do and not blindly endorse the restrictions on an FCE.
How Can I or My Loved One Help Improve Care for People with Complex Regional Pain Syndrome?
If you or a loved one has been diagnosed with CRPS, there are several ways to help improve care and manage symptoms.
- Seek out a specialist: Finding a healthcare provider specializing in treating CRPS is essential. A specialist will have the knowledge and experience to provide the most effective treatment options and help manage symptoms.
- Work with a team: CRPS can affect many aspects of a person's life, so working with a team of healthcare providers is essential. This team may include a pain specialist, physical therapist, occupational therapist, and psychologist. Each team member can help manage different aspects of the condition, providing a more comprehensive approach to care.
- Take a multidisciplinary approach: Because CRPS can affect many areas of a person's life, it's essential to take an interdisciplinary approach to care. This can involve a combination of medication, physical therapy, occupational therapy, psychotherapy, and complementary therapies such as acupuncture or massage.
- Practice self-care: Self-care is an essential part of managing CRPS. This can involve exercise, mindfulness meditation, and stress reduction techniques. Maintaining a healthy lifestyle, including a balanced diet and adequate sleep, can also help manage symptoms.
- Educate yourself: Understanding CRPS is an essential part of managing the condition. Learn about the causes, symptoms, and treatment options. This can help you make informed decisions about your care and communicate more effectively with your healthcare team.
By working together to manage symptoms and improve quality of life, people with CRPS can actively participate in their care and achieve better outcomes.
Securing Compensation for CRPS Patients: A Deeper Look at Legal Pathways
Navigating the legal landscape can be a critical part of the journey when living with Complex Regional Pain Syndrome (CRPS). Securing compensation usually takes one of two main routes: Workers’ Compensation Claims and Personal Injury Lawsuits.
Personal Injury Lawsuits
To pursue a legal claim related to CRPS, it is crucial to have competent and skilled legal representation who understands the nuances of negligence laws, injury attribution, and the burden of proof. An experienced attorney can help evaluate and structure the claim to protect the patient’s rights.
Strong evidence linking the negligent party’s actions to the onset of CRPS is crucial for success. Accurately quantifying damages, including medical costs and pain and suffering, is essential.
Workers' Compensation Claims
For workers' compensation claims related to CRPS, proving how the workplace injury caused the condition is key. A knowledgeable attorney can navigate these complexities, ensuring proper documentation and evidence gathering.
They negotiate with insurance companies, develop medical evidence, and advocate for fair compensation, supporting clients throughout the process.
Doug Maynard
As former State Farm Insurance adjuster, Doug leverages a wealth of experience spanning over three decades across domains like personal injury, workers’ compensation, and insurance claims. With a strong insurance background, Doug Maynard has a history of representing individuals diagnosed with CRPS following ulnar nerve surgeries and fractures.
The Law Offices of C. Douglas Maynard
Trying to understand the legal rights associated with CRPS can be overwhelming.
Nonetheless, equipped with the right legal guidance, these daunting barriers can be crossed. Everyone dealing with the repercussions of CRPS due to a workplace or personal injury deserves equitable treatment and compensation.
The Law Offices of C. Douglas Maynard, Jr., PLLC, works diligently to lend your cause a voice against those who may attempt to diminish your pain. You are welcome to contact us to explore your legal options or discuss your individual case.
Disclaimer: The information provided in this article is for general informational purposes only and does not constitute legal advice. Reading this article or interacting with its content does not establish an attorney-client relationship with Maynard Law. To create such a relationship, a formal agreement is required. Past results mentioned in this blog post do not guarantee future outcomes. Each case is unique and must be evaluated on its own merits.
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