Understanding the Condition and Overcoming Skepticism
Complex Regional Pain Syndrome (CRPS) is a complex and poorly understood neuropathic (nerve-related) pain condition characterized by its relationship to the autonomic (unconscious or involuntary) nervous system. The pain is regional, meaning it is not solely related to a specific nerve territory or dermatome (area of skin that is mainly supplied by a single spinal nerve). Some experts believe that CRPS represents an exaggerated response of the sympathetic nervous system to some form of injury, resulting in chronic and severe pain. CRPS is partly misunderstood because it is often associated with continuing complaints of severe pain that seem disproportionate to any related trauma or possible inciting event. Put another way, CRPS is often associated with reports of a high severity of pain that would seem disproportionate to a related trauma. CRPS is also associated with complaints of pain disproportionate in time, meaning that following a traumatic event, when medical professionals would expect the acute phases of pain and swelling to have subsided, patients are still complaining of high severity pain.
CRPS is often associated with complaints of burning pain present even without stimulation or movement, excessive sweating, swelling, changes in skin color, changes in hair and nail growth, and sensitivity to touch. The pain may begin in one area or limb and then spread to other limbs. Current research suggests that CRPS is not the result of a single disease mechanism, but instead by a complex set of interacting mechanisms within the patient’s body. CRPS will often develop following forceful trauma to an arm or a leg, including fracture, crush, and amputation type injuries. Other more minor traumas such as surgery, sprained ankle, and even injections impacting a nerve can lead to CRPS.
There is no “gold standard” diagnostic test or method for confirming a diagnosis of CRPS. However, a general consensus of criteria used to diagnose CRPS, known as the Budapest Criteria, has emerged. To satisfy the Budapest Criteria, a certain number of both self-reported CRPS symptoms and objective CRPS signs observed by the physician on examination must exist.
Plaintiff’s involved in litigation often must overcome skepticism regarding the diagnosis of CRPS following an accident or trauma, due to its association with pain disproportionate to the trauma and its reliance upon the patient’s own subjective complaints for diagnosis. Inevitably, defense attorneys in cases involving CRPS rely upon a defense that the plaintiff is a malingerer, exaggerator, liar, or simply suffering from a purely psychological disorder of their own making. In order to overcome this skepticism, the subtleties and complexities of CRPS must first be explained to the jury through an expert specialized on the condition. Documentation within the medical record, aside from generalized complaints of pain, which demonstrate the particular symptoms associated with CRPS must be highlighted and explained to a jury. Multiple damages witnesses such as family, friends, and coworkers must be called upon to challenge the defense’s attack on the plaintiff’s character. Only through this multi-pronged approach can a plaintiff suffering from CRPS secure an award commensurate with their outsized suffering.