Removing the complexity from Complex Regional Pain Syndrome (CRPS) cases
Complex Regional Pain Syndrome (CRPS) is one of the most painful types of pain known. Medico legal cases involving chronic pain (pain that lasts for three months or more) is challenging for both the claimant and the defendant to prove or refute because of the subjective nature of pain. This is especially true for cases involving CRPS, partly due to the condition itself but also because the pain that follows the injury is not usually reflective of the original injury sustained and often far worse. Hence the complex disputes that arise regarding causation, liability and prognosis.
The common triggers of CRPS include fractures, sprains, soft tissue injuries such as burns, surgical procedures and limb immobilisation from a cast, splint or brace. It commonly affects a single limb, but other limbs can become involved. CRPS is essentially an abnormal neurological pain response that magnifies the effects of an injury. CRPS is caused by damage or dysfunction of the peripheral and/ or central nervous system and an inappropriate neuroinflammatory response. More than 80% of cases are caused by an accident, injury or surgical intervention and these are the cases where a medico legal claim is often made.
Symptoms of CRPS include severe stabbing or throbbing pain, burning or pins and needles, sensitivity to light touch (allodynia), changes to skin temperature or colour (mottled or discoloured), swelling, stiffness, alteration in hair and nail growth, decreased mobility, contractures and muscle spasms.
Steps to simplify CRPS casesThere are three important steps to take to simplify CRPS cases. Firstly, ensure you engage appropriate experts; secondly, obtain a clear diagnosis and prognosis; and finally, engage and obtain a report from a consultant in pain medicine who specialises in diagnosing and treating CRPS.
- Engage the appropriate expert witnesses
- Consultant in pain medicine – to diagnose, provide a prognosis,
- identify and evaluate the effect on the claimant’s life and provide a
- multidisciplinary treatment plan
- Rheumatologist – to aid in the diagnosis of CRPS
- Orthopaedic consultant – if orthopaedic injuries were sustained prior to onset
- Psychiatrist – to assess the claimant and rule out any psychiatric/psychological issues
- Occupational therapist – to identify care needs
- Obtain a clear diagnosis
- Engage an expert in pain medicine
- Medical history
- Severity of pain
- Impact of symptoms on claimant’s life, ability to function and need for support
- Effect on claimant’s ability to work
- The requirement to take medication to control symptoms and consideration of how the medications will impact the claimant’s daily functioning
- Multi-modal treatment that has been undertaken or can be in the future
Dr Jenner suggests steps to remove complexities from Complex Regional Pain Syndrome (CRPS) cases and has appeared in the May issue of “Your Expert Witness“
Dr Jenner is also speaking at the Burning Nights CRPS Support’s 3rd Annual National CRPS Conference at the Marriott Bexleyheath, Kent on Saturday 4th November.