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 also spread to other areas of the body.
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 Causalgia. While both have similar symptoms, Type 2 is more severe and involves a confirmed significant nerve injury.
Some trauma is the usual cause of CRPS or RSD. Common causes are broken limbs, ligament or muscle tears, and even direct trauma to a nerve. Frequently, these occur in motor vehicle accidents, workplace injuries, slips and falls, and 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 highly complex. For example, showing how a third party directly caused the trauma, which then resulted in a diagnosis of CRPS or RSD, can be challenging. 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 step has its pronounced symptoms.
Stage One, 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 cool. 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 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 in the affected area.
While the mechanism is unknown, 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; many 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 patient’s history and examination.
While there is no definitive test for diagnosing the syndrome, several tests 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 are unlikely any bone structure changes during the initial stages of CRPS.
- Because the pain and inflammation from CRPS will increase blood flow to the affected area, bone scans are commonly used to analyze blood flow.
- Thermography measures temperature changes and blood supply sufficiency to the affected extremities.
In assessing whether a patient has CRPS or RSD, a physician looks at specific 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 discomfort, 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.
Most 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 in 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. The atrophy can sometimes 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 antidepressants as a result.
Most CRPS sufferers can also expect the pain to spread outside the initial affected area. Some studies estimate that pain will extend from the initial site in 77% of CRPS patients.
CRPS treatment revolves around treating the symptoms, primarily pain, as much as possible. Medication and physical therapy are typically the first forms 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, a variety of surgical or other invasive procedures 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 – an electrical device implanted below the skin that delivers mild electrical current to the spinal cord. The current disrupts the standard 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 highly 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 antidepressants and other medications 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 42 and 45 out of 50. For perspective, first-time childbirth (with no training) ranks 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 extend 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. However, the longer it takes for treatment to start, the less likely there will be any remission.
While there is no cure, a variety of treatments can assist CRPS sufferers in coping with the pain.
CRPS and RSD Lawsuits and Damages
CRPS typically results in chronic, debilitating pain and 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.
Typically, CRPS sufferers cannot continue working, ending up on disability. For most, this results in a drastic drop in their current and future income and benefits.
Some trauma almost always causes CRPS to an extremity. Broken limbs from a car accident or fall can lead to CRPS. Also, just about any surgery on an extremity and any venipuncture or IV procedure can lead to CRPS.
You should seek legal assistance if you have CRPS and suspect some third party may have caused it. The law limits the 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 case:
- Past, current, and future medical bills – CRPS sufferers have typically incurred significant medical bills and face future medical costs.
- Past, current, and future lost wages – most CRPS patients are eventually unable to continue working and therefore face significant lost future income and past income for work.
- Life care planning expenses – CRPS sufferers can typically expect significant future medical and personal needs throughout their lives. 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 and the expectation that this will last their entire life.
- Lost earning capacity – which is different from lost future wages. This form of damage predicts how the injury will diminish the victim’s future earning power. In essence, it calculates how much the injury has reduced future earnings.
Doyle APC attorneys know the catastrophic impact CRPS can have on the sufferer and family members. To discuss the specifics of your situation and whether legal remedies may exist, complete our contact form for a free case review 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 tricky to diagnose, you should consider going to a specialist with experience treating CRPS, such as Pain Management Specialist or Neurologist.