Complex Regional Pain Syndrome (CRPS) is one of the most devastating and perplexing conditions that can occur following an accident. It does not distinguish where the accident occurred, whether it be a work injury, car accident, or fall at home. It is likely one is not aware of this condition unless there is a personal connection to it. Seeing it first hand is typically the first encounter whether it be a friend or family member. 

CRPS is a somewhat rare condition that occurs following a trauma to a particular body part, and this chronic pain condition usually affects one limb after an injury in a disproportionate way.[1] Divided into two subcategories, Type I and Type II, CRPS Type I is sometimes referred to as Reflect Sympathetic Dystrophy (RSD)[2] while CRPS Type II also receives the name of causalgia.[3] The distinction between the two is that CRPS II involves a nerve injury.[4] 

Diagnosis

The diagnostic protocols for CRPS have changed over time. There is not a single definitive test to determine if one has CRPS. The diagnostic criteria accepted by the International Association for the Study of Pain (IASP)[5] also referred to as the “Budapest Criteria” is as follows:

1. Continuing pain, which is disproportionate to any inciting event.
2. Report at least one symptom in three of the four following categories:

• Sensory: reports of hyperalgesia [increased sensitivity to pain] and/or allodynia [increased response to non-painful stimulation].
• Vasomotor: reports of temperature asymmetry and/or skin color changes and/or skin color asymmetry.
• Sudomotor/Edema: reports of edema [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, nails, skin).

1. 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 deep somatic pressure and/or joint movement).
• Vasomotor: Evidence of temperature asymmetry and/or skin color changes and/or asymmetry.
• Sudomotor/Edema: Evidence of edema 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, nails, skin).

1. There is no other diagnosis that better explains the signs and symptoms. [definitions added].[6]

Symptoms

The symptoms of this condition are essentially outlined within the diagnostic criteria. They include increased pain at the trauma site, but at a disproportionate level to what is expected. Essentially, when most people would report a pain level of 2 out of 10, a person suffering from CRPS could report an 8 out of 10. Other symptoms include temperature variance between the limbs. One hand or leg could be colder or hotter than the other. Swelling, sweating, and color changes from one limb to the other are different. Hair and nail differences are also positive findings for this condition. The severity of these differences is significant from person to person. 

Causes

The cause of this condition is probably just as frustrating as the treatment from a physician’s perspective. There is no singular method of determining cause since an inciting event or trauma is generally just the first domino in a series of CRPS development. This can create a particular challenge in pursuing workers compensation claims since employers and insurers will try to build a case that focuses on the subtlety of the causes and symptoms.

From that inciting event, it is likely that dysfunction is occurring within the nervous system signaling and/or hormone regulation.[7] The wrong signals for pain, inflammation, and the immune system are all potential culprits for why the body reacts to a trauma in this particular manner. [8] Additionally, there is some evidence to suggest individuals could be genetically predisposed to the condition.[9] As well as there being several psychological states that can increase the instance or severity of the condition including: anxiety, stress, catastrophizing, perception of disability, and pain-related fear.[10]

Treatment

Treatment for CRPS is essentially a trial and error period for every patient. The physician can start with the most commonly successful strategies but will likely adjust and change based upon the particular response of the patient.  Physical, occupational, and psychological therapy are utilized quite often in CRPS patients. Their goal is to improve function, quality of life, and manage the pain.[11] These therapies can range from simply improving movement from a physical therapy perspective, or disassociating the abnormal pain belief psychologically.[12]

Medication management is used significantly in the treatment of CRPS. Nerve pain medication such as gabapentin, amitriptyline, and carbamazine have all been studied and show some success in reducing pain.[13] Anti-inflammatory medications including steroids have been used to help reduce the abnormal inflammatory responses that are often present in the condition.[14] Depending on the symptom presentation, some physicians have tried bisphosphonates to treat patients suffering from bone issues with the condition.[15] 

Beyond medication, there are additional treatments with hopeful outcomes. Spinal Cord Stimulation is used to change how the nervous system sends signals back and forth with the goal of reducing pain and improving quality of life.[16] Dorsal root ganglion stimulation is also a newer developing treatment that could help reduce pain in patients.[17]

All of these treatments offer significant aid in lessening the chronic pain, but they rarely cure the syndrome, only dulling the strength of the symptoms. The treatments can be pricey and not always covered by a health insurance company. Therefore, workers who believe their CRPS started due to work injury or environment may have a claim for workers compensation.

Complex Regional Pain Syndrome and Workers Compensation

In the event of a work injury that results in Complex Regional Pain Syndrome, it’s possible that the worker is eligible for workers compensation. Sometimes, daily work responsibilities can exacerbate the symptoms of CRPS, and this may mean eligibility for more financial or medical help. CRPS is a severe condition with no cure.

At Carrillo & Carrillo, our goal is to help you receive your legal right to compensation for work injuries and personal injury. If you are uncertain about whether or not your situation qualifies for legal assistance, reach out to our office today by emailing office@carrilloinjurylaw.com.

Sources

[1] https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Complex-Regional-Pain-Syndrome-Fact-Sheet
[2] https://en.wikipedia.org/wiki/Complex_regional_pain_syndrome
[3] https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Complex-Regional-Pain-Syndrome-Fact-Sheet
[4] Complex regional pain syndrome: a narrative review for the practising clinician
[5] https://www.iasp-pain.org/Membership/SIGDetail.aspx?ItemNumber=753
[6] https://s3.amazonaws.com/rdcms-iasp/files/production/public/Content/ContentFolders/Publications2/ClassificationofChronicPain/Part_II-A.pdf
[7] Complex regional pain syndrome: a narrative review for the practising clinician

[8] Id.
[9] Id.
[10] Id.
[11] Id.
[12] Id.
[13] Id.
[14] Id.
[15] Id.
[16] Id.
[17] Id.