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Complex regional pain syndrome and personal injury claims

A guest post by Ruth Magee, a senior associate solicitor at Manchester law firm Express Solicitors

Magee: Multi-disciplinary approach needed

Complex regional pain syndrome (CRPS) is a poorly understood chronic pain condition (lasting more than six months) in which a person experiences persistent severe and debilitating pain. It is usually confined to one limb but can spread to other parts of the body.

Most cases of CRPS are triggered by an injury or trauma and the resulting pain is much more severe and long lasting than normal, and disproportionate to the initial event.

CRPS is believed to be caused by damage to, or malfunction of, the peripheral and central nervous systems. The central nervous system is composed of the brain and spinal cord; the peripheral nervous system involves nerve signalling from the brain and spinal cord to the rest of the body.

There are two types of CRPS:

Type 1 (RSD): Where the symptoms come on after a trauma/injury to the affected area but where there is no actual damage to the nerves. This is the most common form of CRPS and accounts for the majority of diagnosed cases

Type 2 (Causalgia): This comes on after a distinct injury to the nerves. This is a rarer form of CRPS, and the symptoms here tend to be more painful and difficult to control.

Who can get CRPS?

Studies have found that although it is more common in women, CRPS can occur in anyone at any age, with a peak at age 40. It is rare in the elderly. Very few children under age 10 and almost no children under five are affected.

Symptoms of CRPS

The key symptom is prolonged severe pain that may be constant. The severity of symptoms ranges from self-limiting and mild to severe and debilitating.

Symptoms may change over time (even numerous times a day) and they can vary from person to person. Sufferers can experience a range of symptoms such as:

In very rare cases, CRPS can also lead to further physical complications, such as skin infections, ulcers, muscle atrophy and muscle contractures.

What causes CRPS?

CRPS is uncommon. It is unclear why some individuals develop CRPS, while others with similar trauma do not. In more than 90% of cases, the condition is triggered by a clear history of trauma or injury.

The most common triggers are:

Diagnosis and prognosis

The diagnosis of CRPS is based on clinical findings which exclude other possible causes.

A number of diagnostic tests can help eliminate other causes and confirm a diagnosis such as:

Currently there is no specific test which can confirm CRPS. It is a diagnosis based on a person’s medical history, and signs and symptoms that match the definition. Since other conditions can cause similar symptoms, careful examination is important.

The outcome of CRPS is highly variable. Younger persons, children and teenagers tend to have better outcomes. While older people can have good outcomes, there are some individuals who experience severe pain and disability despite treatment.

How is CRPS treated?

Treatment is most effective when started early and involves a multi-disciplinary approach. It is best for a specialty pain clinic to assess and determine a plan.

The following treatment therapies are often used:

Who to instruct for a medico-legal report?

In order to be able to fully assess the extent of your client’s injuries, it is good practice to instruct a multi-disciplinary team of experts to arrive at an accurate diagnosis and prognosis of the injuries and to recommend a treatment plan.

Depending upon the nature of the symptoms, you should consider reports from a consultant in pain medicine, an orthopaedic consultant, a rheumatologist, a neurologist, a psychiatrist, and an occupational therapist.

Recent reported cases of interest

KM v Surya Hotels Ltd (2017)

The claimant, a woman aged 45, received £4m after slipping over a step and injuring her right ankle. She developed CRPS and fibromyalgia. The claimant experienced symptoms including depression, chronic fatigue and cognitive problems and her leg was later amputated.

Barnett v Leonard Cheshire Disability (2017)

The claimant, a 44-year-old woman, received £375,000 for her knee injury and subsequent diagnosis of CRPS after slipping on some spilt water at work. She suffered pain in different areas of her body, nightmares, flashbacks, panic attacks and limited mobility. The claimant was unable to work and required ongoing care and assistance.