Complex Regional Pain Syndrome explained

Complex Regional Pain Syndrome (CRPS) is a problem that is receiving more attention in the personal injury field. As the name implies, it is a complex injury and one that has provoked considerable debate.

If you have suffered an injury of this nature or whiplash in an accident within the last three years, you may be entitled to claim compensation for your pain and suffering. CRPS claims CRPS is, as the name implies, a syndrome.   This is a collection of symptoms (what the patient reports) and signs (what the doctor finds on examination), but behind which there is not a clearly unified pathological process. It is usually precipitated by comparatively minor trauma (in most instances), and frequently immobilisation .

Along with the pain is the development of a variety of changes which would often be associated with abnormalities of the sympathetic nervous system (hence the former diagnosis of reflex sympathetic dystrophy), namely changes in the blood supply, giving rise to alterations in the colour and temperature of the limb, changes in sweating, changes in appearance of the limb which becomes swollen, shiny and hairless.   Finally there are changes to the muscles, in particular muscle wasting.

The modified clinical diagnostic criteria for CRPS are:

1) Continuing pain which is disproportionate to the inciting event

2) Must report at least one symptom in three of the four following categories (a) Sensory: Reports of hyperaesthesia and/or allodynia (b) Vasomotor: Reports of temperature asymmetry and/or skin colour changes and/or skin colour asymmetry (c) Sudomotor/oedema: Reports of oedema and/or sweating asymmetry (d) Motor/Trophic: Reports of decreased range of motion and/or motor dysfunction (weakness, tremor, dystonia) and/or trophic changes (hair, nails, skin)

3) Must display at least one sign at time of evaluation in two or more of the following categories: (a) Sensory: Evidence of hyperalgesia (to pinprick) and/or allodynia (to light touch and/or deep somatic pressure and/or joint movement). (b) Vasomotor: Evidence of temperature asymmetry and/or skin colour changes (c) Sudomotor/oedema: Evidence of oedema and/or sweating changes and/or sweating asymmetry. (d) Motor/Trophic: Evidence of decreased range of motion and/or motor dysfunction (weakness, tremor, dystonia) and/or trophic changes (hair, skin, nails)  

4) There is no other diagnosis that better explains the signs and symptoms” (p55)

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