Complex Regional Pain Syndrome (CRPS) also called Reflex sympathetic dystrophy (RSD) is a chronic, progressive nerve condition that causes debilitating pain. This little known syndrome is considered the most severe type of chronic pain currently known. It usually affects one or more of the extremities but it can spread to other areas of the body as well.
CRPS and RSD cause severe pain and can result in the functional loss of limbs. There are two types of CRPS: Type 1, formerly known as RSD (Reflex Sympathetic Dystrophy) and Type 2, formerly known as Causalgia. While both have the same or similar symptoms, the difference is Type 2 is more severe and involves a confirmed, major nerve injury.
Some type of trauma is the usual cause of CRPS or RSD. Many common causes are broken limbs, ligament or muscle tears, and even direct trauma to a nerve. Frequently these are things that occur in motor vehicle accidents, workplace injuries, slip and falls as well as medical procedures such as surgery, venipuncture and IV placement. These causes are frequently the result of some third-party’s negligent act, giving rise to a claim for compensation.
CRPS is a life-altering condition typically requiring tremendous amounts of future medical care and leading to injuries such as lost income from an inability to work. Many physicians and attorneys lack familiarity with CRPS and do not comprehend its devastating effects.
CRPS lawsuits can be extremely complex. For example, showing how a third-party directly caused the trauma which then resulted in a diagnosis of CRPS or RSD can be quite difficult. Before hiring a lawyer, CRPS sufferers should ensure the attorneys are qualified and experienced in CRPS cases.
The Symptoms and Stages of CRPS and RSD
CRPS usually affects one or more of the extremities. The symptoms of CRPS progress in three stages and each stage has its own pronounced symptoms.
Stage One, which is typically the first 1 to 3 months after onset, is characterized by burning pain, swelling and hypersensitivity to touch. There are also color and temperature changes to the affected extremity (the area is red and warm).
Stage Two when the patient experiences constant pain and swelling, the skin appears bluish and is cool to the touch. The patient also experiences burning pain, muscle stiffness, and atrophy. The swelling may spread, hair growth in the area decreases, and the nails become cracked and brittle.
Stage Three is characterized by severe pain which may involve the entire affected limb. There is distinct muscle atrophy, limited mobility, and contractions of the muscles and tendons of the affected area. Additionally, the skin around the affected area appears cool and shiny.
The Possible Causes of CRPS and RSD
The exact biological mechanism of CRPS is not yet known. The most common theory is that CRPS is caused by an immune response that causes inflammation, redness, and warmth to the affected area.
While the mechanism is not yet known, the most common cause of the syndrome is some form of trauma.
CRPS frequently results from broken limbs, surgical procedures, venipuncture procedures (blood draw), and IV insertions. The trauma can be mild as a large number of cases come from soft tissue injuries such as sprains and tears.
CRPS and RSD Diagnoses
CRPS is difficult to diagnose. Because of this, it is common for CRPS to go undiagnosed for months and even years before a proper diagnosis is made.
There is no definitive diagnostic test for CRPS so diagnosis is based on each individual’s patient history and examination.
While there is no definitive test for diagnosing the syndrome, there are a number of tests that can either rule out CRPS or confirm aspects of the syndrome. These include
- Nerve conduction studies are used to determine whether nerve function is normal.
- X-rays may be used to examine any changes in bone structure. This is typically done by comparing x-rays taken over time as there is unlikely to be any bone structure changes during the initial stages of CRPS.
- Because the pain and inflammation from CRPS will result in increased blood flow to the affected area, bone scans are commonly used to analyze blood flow.
- Thermography measures temperature changes and the sufficiency of blood supply to the affected extremities.
In assessing whether a patient has CRPS or RSD, a physician looks at certain diagnostic criteria identified by the International Association for the Study of Pain (IASP). These include
- The presence of an initiating tissue-damaging event or a cause of immobilization
- Continuing pain, the perception of pain from something that would typically not cause pain such as someone touching your skin, or an exaggerated sense of pain disproportionate to the cause
- Evidence of edema, changes in skin blood flow causing a bluish or purplish color, or abnormal sweating in the area of pain
- Exclusion of the existence of any other condition that could account for the degree of pain and dysfunction
Risk Factors for developing CRPS and RSD
It is estimated that between 1.5 and 3 million Americans suffer from CRPS/RSD.
It disproportionately affects women who account for approximately 75% of all cases. The reason women are disproportionately affected is not known.
The majority of victims develop the disease in their 20s and 30s, however, it can affect people of all genders and age groups, including children.
Prognosis and Treatment for CRPS and RSD
There is no cure for CRPS. However, if diagnosed early (within months of onset) and treatment begins as quickly as possible, then there is a chance the syndrome will go into remission. While early treatment may result in remission, this is almost always temporary and the symptoms will probably return.
If CRPS is diagnosed much later resulting in a delay of treatment, the progress of the disease may be irreversible. In short, the longer treatment is delayed, the worse the probable outcome. Unfortunately, because CRPS is difficult to diagnose, early treatment is not the norm resulting in crippling and irreversible changes.
Chronic pain is not the only damage that CRPS may cause. Due to the impairment of the affected extremity, there can be a degradation of muscle tissue and function (atrophy), leaking from dilated blood vessels as well as possible degradation of bone structure in the affected area. In some cases, the atrophy can be so severe that it can lead to amputation.
There is also the emotional and psychological toll that chronic pain can cause. Many CRPS patients end up taking anti-depressants as a result.
Most CRPS sufferers can also expect the pain to spread outside of the initial affected area. Some studies estimate that pain will spread from the initial site in 77% of CRPS patients.
CRPS treatment revolves around treating the symptoms, primarily pain, as much as possible. Medication along with physical therapy is typically the first form of treatment. This usually involves narcotics for pain, steroids for inflammation and antidepressants to help with the emotional and psychological toll.
For many patients, medication only provides some relief or temporary relief. For these individuals, there are a variety of surgical or other invasive procedures that are commonly performed. These include
- Nerve Blocks – a procedure where the spinal column is injected with anesthesia to numb the nerves in the affected area
- Internal Pain Pumps – an implant that provides pain medication through a catheter directly to the spinal column. Because the drug is placed directly into the spinal column it is usually far more effective than traditional pain medication
- Spinal Cord Stimulators – is an electrical device implanted below the skin that delivers mild electrical current to the spinal cord. The current disrupts the normal pain signals to the brain essentially fooling the brain into believing there is no pain
- Surgical Sympathectomy – a last resort method of treatment that is extremely invasive. It involves cutting the nerves which prevent the brain from relaying pain signals to the affected area
Due to the emotional and psychological toll that chronic pain can cause, many CRPS sufferers take anti-depressants and other medication to help with these effects.
CRPS Pain and Migration
CRPS has been described as the most severe form of chronic pain currently known to medical science.
One of the most commonly used measures of pain is the McGill Pain Index which measures pain on a scale of 0 to 50. CRPS ranks as a 42 and 45 out of 50. For perspective, first-time childbirth (with no training) ranks as a 40 out of 50 and amputation of a finger or toe scores 40 out of 50. Other notable pain rankings include chronic back pain (27 out of 50); a fracture (17 out of 50) and a toothache (20 out of 50).
CRPS typically spreads beyond the affected area and on some occasions will spread to other extremities.
There is also a correlation between the length of time from injury to diagnosis and the likelihood of CRPS spreading. The longer it takes for treatment to begin the greater the risk it will spread. Some studies show that more than 70% of CRPS cases will spread to other areas.
There is no current cure for CRPS. But early treatment can result in CRPS going into remission and the patient being non-symptomatic for periods of time. However, the longer it takes for treatment to start the less likely there will be any remission.
While there is no cure, there are a variety of treatments that can assist CRPS sufferers to cope with the pain
CRPS and RSD Lawsuits and Damages
CRPS typically results in chronic, debilitating pain as well as limited function in the affected extremities. CRPS sufferers face a lifetime of medical treatment which may include extremely costly treatments, such as internal pain pumps and spinal stimulators.
Normally, CRPS sufferers are unable to continue working eventually ending up on disability. For most, this results in a drastic drop in their current and future income and benefits.
CRPS is almost always caused by some trauma to an extremity. Broken limbs from a car accident or fall can lead to CRPS. Also, just about any surgery to an extremity, as well as any venipuncture or IV procedure, can lead to CRPS.
If you have CRPS and suspect that it may have been caused by some third-party, you should seek legal assistance. The law limits the amount of time during which you may bring a lawsuit. If you wait too long it may result in any claim you have being time-barred.
Below are the most common types of damages seen in CRPS cases. Not all cases are the same so all these damages may not be available in every CRPS cases:
- Past, current and future medical bills – CRPS sufferers have typically already incurred significant medical bills and face future medical costs as well.
- Past, current, and future lost wages – most CRPS patients are eventually unable to continue working and therefore face significant lost future income as well as past income for work.
- Life care planning expenses – CRPS sufferers can typically expect significant future medical and personal needs, likely over the course of their entire life. A life care plan evaluates the individual CRPS sufferer to determine what those future needs will be and then itemizes those costs in the form of a life care plan.
- Pain and suffering – CRPS sufferers will have already experienced tremendous past pain and suffering as well as the expectation this will last their entire life.
- Lost earning capacity – which is different from lost future wages. This is a form of damages that predicts how the injury will diminish the victim’s future earning power. In essence, calculating how much the injury has diminished future earnings.
Doyle APC attorneys are knowledgeable about the catastrophic impact CRPS can have on the sufferer as well as family members. Our attorneys would be happy to discuss the specifics of your situation and whether legal remedies may exist. Please fill out our confidential form or call 1-800-736-9085.
** If you or a family member has some or all of the symptoms of CRPS you should see a physician immediately. Because CRPS is notoriously difficult to diagnose you should consider going to a specialist who has experience in treating CRPS such as Pain Management Specialist or Neurologist.