By David Dean, Senior Associate Solicitor at Legal Futures Associate Express Solicitors
This blog is intended to raise awareness of Complex Regional Pain Syndrome (CRPS) and to highlight the complexity of the condition in the personal injury and clinical negligence arena.
CRPS is a form of chronic pain that affects a number of elements / parts of the body. It is often characterised by pain that lasts longer than the normal recovery period for an injury.
The majority of CRPS cases are caused by an accident or trauma resulting in injuries such as a bone fracture. Alternatively, CRPS can stem from surgical procedures and infections. That said, there are a number of cases when the symptoms do commence sporadically.
When considering the McGill Pain Scale, CRPS is regarded as the most serious pain condition that can be experienced. Out of a score of 50, CRPS scores 42.
CRPS can present in and spread to all areas of the body including internal organs. Whilst CRPS is not a psychological condition it is known that non- stop pain can lead to someone with CRPS having difficulties with their mental health. Further, CRPS can lead to cognitive issues.
There are 3 sub subtypes of CRPS: –
- Type 1 (no damage to a nerve) / Type 2 (damage to a nerve)
- Not Otherwise Specified (when a patient has some symptoms, but their condition be best described as something else)
- CRPS with Remission of Some Factors (where the patient has formally had CRPS, but some symptoms are in remission).
The most common CRPS suffered is type 1.
One issue in understanding the demographic for CRPS is that even though the condition affects more women than men and predominantly those aged between 30 and 55, there are exceptions to the norm and the symptoms can vary from one person to another.
Since 2004 medical professionals have been diagnosing the condition using the Budapest Criteria.
- The starting point is that there needs to be lasting pain which is disproportionate to the index incident i.e. the accident / trauma as mentioned above.
- Then there are 4 key areas that are considered. The patient needs to report symptoms in 3 of the following categories whilst a doctor needs to see signs of symptoms of out of the categories:
- Sensory (change in sensitivity)
- Vasomotor (issues with temperature)
- Sudomotor / Oedema (issues with sweating)
- Motor / Trophic (decreased range in limb motion or issues with nerve/ muscles).
- The final stage of the criteria is that there is no other diagnosis that can better fit the symptoms.
For the purpose of the blog I will not provide an in depth evaluation of the symptoms set out in the 4 categories above, but simply highlight the issues that are posed by the first and last part of the Budapest Criteria to enable a successful personal injury / medical negligence claim to be made.
It is understood that a number of patients can experience a decrease in their pain within 2 years of an accident. However, there are a number of people with CRPS that experience continuous pain despite treatment.
There are a number of more well known treatments available to those with CRPS including physical rehabilitation often at a pain clinic with techniques such as physiotherapy, psychological treatment including CBT, pain relief, nerve blockers, spinal cord simulators neuromodulation and neurostimulation to name just a few.
In order to gain access to such treatment, a CRPS diagnosis has to be made. Therefore, time is of the essence in treating / managing the condition with any of the above methods set out above.
This is also true for bringing a personal injury / medical negligence claim given the limitation period in England and Wales.
As highlighted above, the diagnostic criteria for CRPS is dependent on medical professionals waiting for the initial injury to heal in line the average prognosis periods and ruling out other conditions. As such, it is concerning that sufferers of CRPS may not have a formal diagnosis until after a number of years. Therefore, they may not be responsive to treatment and also the limitation period may have expired to bring a personal injury / medical negligence claim.
Therefore, it is imperative that those that have been injured in an accident act promptly in accessing treatment at the earliest opportunity. Thereafter patients and medical professionals alike should monitor the extent of symptoms in line with the recognised prognosis period. Where appropriate and if symptoms are persisting, they should seek input / a referral to an appropriate Pain Consultant to consider the diagnosis of an appropriate pain condition including CRPS.
It is imperative that legal professionals are also alive to the condition and have an understanding of when a claim they are handling may become a case where the Claimant is suffering with a pain condition / CRPS.
This will not only allow the Claimant to have access to the most appropriate treatment at the earliest stage possible but also ensure that damages are maximised and the Claimant is awarded the most appropriate level of damages.