Complex Regional Pain Syndrome (CRPS)

Complex Regional Pain Syndrome (CRPS) is an extremely painful condition where suffers experience persistent, severe, and debilitating pain, which can have a huge impact on their physical and mental wellbeing.

Sufferers of CRPS can often feel confused about their condition, with particular uncertainty surrounding the management and treatment of pain.

What is Complex Regional Pain Syndrome?

Complex Regional Pain Syndrome is a form of chronic pain that causes long-lasting suffering and discomfort to those who are afflicted by the condition. Most cases of CRPS are triggered by an injury, with the resulting pain more serious and long lasting than would normally be expected from an accident.

Awareness and understanding of CRPS is relatively low, despite the fact that more than 28 million people in the UK are estimated to suffer from some form of chronic pain. Due to a lack of understanding, sufferers of CRPS are often misdiagnosed.

There are two recognised types of CRPS:

  1. Type 1: Reflex Sympathetic Dystrophy (RSD) – RSD is the most common form of CRPS and usually follows an injury to a specific area of the body. RSD is characterised by damage to a certain area but does not involve nerve damage.
  2. Type 2: Causalgia – this develops after a distinct injury to the nerve. Causalgia is rarer than RSD and its symptoms are usually more painful and difficult to manage. Sufferers often feel a severe burning pain in a limb, which is caused by nerve damage.

Who Can Get CRPS?

Anyone can develop CRPS following an accident or injury. CRPS can develop at any age and affects both men and women, although it is much more common in women – 3 out of 4 cases of CRPS is reported in women. CRPS rarely affects the elderly or young children; however teenagers can be susceptible to the condition following an injury.

The average age for the onset of symptoms is around 50 and it is estimated that 1 in 3,800 people in the UK develop CRPS every year.

What are the symptoms of CRPS?

The main symptom of CRPS is chronic pain, as sufferers often report ongoing, debilitating pain after developing the condition. This chronic pain can manifest itself in a number of ways and some of the most common symptoms associated with CRPS include:

  • A burning, intense, and ‘stabbing’ pain, also described as ‘cold pain’
  • Feeling pain from the lightest of touches – the medical term for this is allodynia. This is usually characterised by experiencing a painful reaction to something that would not normally hurt, such as stroking the skin with a feather
  • Experiencing pain from pressure or temperature that would not normally cause pain – this is often described by its medical name, hyperalgesia
  • Continued intense pain after injury where normally the individual would have been expected to make a full recovery
  • Abnormal swelling in the area affected, also known as oedema
  • Changes in skin colour or mottled appearance to the skin
  • Excessive sweating in the affected area
  • Abnormal nail growth and/or abnormal hair growth
  • Abnormal skin temperature in the affected area
  • Joint tenderness and/or stiffness
  • Cracked, grooved or brittle nails
  • Tremors and muscle spasms, known as dystonia

What causes CRPS?

Medical experts are not sure what causes some individuals to develop CRPS after a trauma, while others who suffer the same injury do not develop a long-term condition. The vast majority of sufferers, some 90%, have a clear history of trauma or injury prior to developing CRPS.

The most common triggers of the condition are fractures, sprains or strains, soft tissue damage (burns, cuts, or bruises), limb immobilisation (such as wearing a cast), or medical procedures and mistakes. Due to the amount of bones, nerves, and tendons in the hand, injuries affecting this area of the body are quite susceptible to causing CRPS.

Essentially, if nerves are directly or indirectly damaged as a result of an accident, or an injured person needs surgery to repair their injury, they can go on to develop the condition.

How is CRPS diagnosed?

At present, there is no single diagnostic test to confirm CRPS.

Several other conditions can present symptoms synonymous with CRPS, so individuals are usually tested for those conditions and CRPS will only be diagnosed after these are ruled out.

When attempting to diagnose the cause of an individual's pain, medical professionals will take into account their medical history and will consider the presentation of pain symptoms. If diagnosed with CRPS, patients will be referred to their local pain clinic for expedited treatment.

CRPS is often misunderstood and misdiagnosed.

If you experience any unusual symptoms or your pain is burning and intense and does not seem to be improving after an injury, we strongly recommend that you ask to be referred to your local pain clinic.

What is the prognosis and how is it treated?

The prognosis for CRPS varies widely between individuals.

As there is no known cure for CRPS, treatment relies upon several unproven therapies and alternative treatments, as many recommendations are only supported by anecdotal evidence from other sufferers.

Treatment for CRPS focuses on managing the symptoms of pain and there is not a single therapy or management programme that will benefit every sufferer.

When treating other chronic pain conditions, medical professionals usually advise a dedicated multidisciplinary pain management programme, as this can offer a range of benefits for sufferers. A collaborative approach is the preferred model and the earlier a person can access a pain management programme the better the outcome is likely to be.

A package of rehabilitative treatment for a person suffering from CRPS may include:

  • Prescribed pain relief medication
  • Physical rehabilitation, including input from occupational therapists and physiotherapists with psychological support
  • The fitting of a spinal cord stimulator (in severe cases where other methods of pain control do not work). This involves a device being surgically implanted, which uses electric currents to control and manage pain.

Many people suffering from chronic pain conditions, especially CRPS, can experience psychological symptoms and can develop further psychiatric disorders. This can be because living with a long term pain condition can be very distressing and cause depression and anxiety. Accessing psychological treatment and support can be extremely beneficial to people caught in a cycle of chronic pain.

It is important that any treatment or pain management programme for CRPS includes psychological support to help sufferers deal with the mental anguish caused by chronic pain.

How can Simpson Millar LLP help?

If you’ve been involved in an accident and we can prove that it wasn’t your fault, then our dedicated lawyers will commission an independent medical report with regards to the injuries you sustained in the accident.

Our specialist team are trained to spot keys indicators within those reports which may suggest an individual is suffering from CRPS.

Due to the importance of early intervention when managing chronic pain conditions, we may be able to secure interim payments, which will allow you, or a loved one, to access the best immediate treatment for your chronic pain condition.

Organising appointments with dedicated pain management experts, our team of chronic pain specialists will ensure you receive a clear diagnosis and can access the appropriate treatment and pain management programmes to help you cope with the symptoms associated with CRPS.

How much compensation could I receive?

Guidelines on the value of CRPS compensation falls under chronic pain claims, with Judicial College (JC) Guidelines considering the following factors when valuing compensation claims for CRPS:

  • The level of pain experienced by the sufferer
  • The overall impact of symptoms
  • Whether the claimant's ability to work has been affected
  • Whether medication is required to manage pain, if so the costs and effect medication could have on daily life will be considered
  • The extent of current treatment and the predicted effect of future treatment
  • The areas of the body affected by the chronic pain condition
  • Whether the sufferer has developed, or is likely to develop, a psychiatric disorder because of their continued pain
  • The age and prognosis of the claimant

JC Guidelines that relate specifically to CRPS and RSD break down the levels of pain, and the amount of compensation that should be awarded, as follows:

  • Moderate: For claimants suffering from moderate symptoms of CRPS, the compensation bracket is £21,300 to £39,900, which increases to £23,430 to £43,890 with a 10% uplift. The lower end of this bracket will apply where symptoms have persisted for some years but vary in intensity and medication can relatively manage pain symptoms. The higher end of this bracket could be awarded in cases where extensive pain has had a significant effect on a claimant's life but the prognosis assumes an improvement in the future.
  • Severe: For those suffering from severe symptoms of CRPS, the bracket for compensation ranges from £39,900 to £63,850 – this increases to £43,890 to £70,240 with a 10% uplift. Symptoms will be considered as severe if a claimant's ability to work has been greatly reduced because of their CRPS and they have to pay significant costs for extended care and domestic assistance. Psychological problems may also be present and pain is likely to have spread to other limbs.

These figures are based on JC Guidelines and every case will be judged on their individual circumstances, however these generic compensation brackets are useful for giving claimants an idea of how much they could be awarded to help them manage the symptoms of CRPS.

CRPS Key Facts

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Melanie Burden | Partner, Head of Personal Injury | Simpson Millar LLP

Melanie Burden
Head of Personal Injury

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