Chronic Regional Pain Syndrome (CRPS) and Workers' Compensation—What You Need to Know About Your Benefits

Workplace injuries are serious business, the results of which impact not only the employee but also his or her family. With proper medical treatment, most sprains, factures, and soft tissue injuries will heal, and the injured worker can resume a normal routine. However, for others, the scenario is much different.

Following an injury some people suffer from Complex Regional Pain Syndrome (CRPS), which causes chronic pain in the arms, legs, hands or feet. Also known as Reflex Sympathetic Dystrophy (RSD), this condition causes severe and continuous pain (much worse than the initial injury) that can last for months, and even years, and in some instances it never goes away.

What is Complex Regional Pain Syndrome?

CRPS is a chronic (lasting more than six months) pain condition that usually affects one limb following an injury.  It is believed to be caused by damage to, or malfunction of, the peripheral and central nervous systems. 

The brain and spinal cord comprise the central nervous system, whereas the peripheral nervous system involves nerve signaling from the brain and spinal cord to the rest of the body. 

CRPS is Divided into Two Types:  CRPS-I and CRPS-II.

CRPS- 1, initially referred to as Reflex Sympathetic Dystrophy, involves soft tissue injuries, such as burns, sprains, strains and tears. No underlying nerve injury is involved. Examples include:

• Bursitis
• Arthritis
• Tendonitis

Onset is usually a few weeks after the injury, and persists indefinitely if not treated.

CRPS-II, previously known as causalgia, involves a clearly defined injury to a major nerve. In such cases there is a high-velocity impact (such as a bullet wound) that occurred at the site and is clearly associated with nerve injury. It was first documented more than 100 years ago by doctors concerned about the pain that Civil War veterans suffered even after their wounds had healed. It can occur immediately after an injury or months later. There is usually no spontaneous remission if left untreated, but it is possible.

What are the Symptoms of CRPS?

Symptoms of CRPS may change over time and vary from person to person. Occasionally the symptom may spread from its source to elsewhere in the body, such as the opposite limb. In some people, signs and symptoms of CRPS subside on their own. In others, signs and symptoms may persist for months to years. Treatment is likely to be most effective when started early in the course of the illness.

According to the National Institute of Neurological Disorders and Stroke (NINDS), symptoms include the following: 

• Changes in the skin texture of the affected area
• Abnormal sweating pattern in the affected area
• Changes in nail and hair growth patterns
• Stiffness in affected joints
• Muscle coordination problems
• Tremors or jerking of the limbs
• Abnormal limb movement

How is CRPS Diagnosed?

Patients who seek medical care will be asked about their medical history. The physician will be on the lookout for swollen joints and changes in skin temperature and appearance. A diagnosis will be based on clinical findings that exclude other possible causes.

There are a number of diagnostic methods that can confirm a diagnosis, including:

• Blood tests that can help exclude infection or inflammation in the joints as a possible cause.
• Scans, such as ultrasound, may be used to rule out a blood clot, known as deep vein thrombosis.
• Thermography uses an infrared camera to detect heat patterns and blood flow in body tissues.
• Electrodiagnostic testing obtains information about diseases by recording the electrical activity of body parts or by measuring their response to external electrical stimuli.
• X-rays can identify any mineral loss in the bones in the later stages of CRPS.
• MRIs are able to detect tissue irregularities.

Treatment for CRPS

There are a variety of therapies used to treat CRPS according to the NINDS, including:

• Rehabilitation and physical therapy
• Psychotherapy
• Medications
• Sympathetic nerve blocks
• Spinal cord stimulation

Obtaining Workers' Compensation Benefits for Chronic Pain Conditions

CRPS is a debilitating condition that can impact the ability to perform routine activities of daily living and impact the ability to return to gainful employment.

If the initial injury that resulted in CRPS occurred at work, the injured employee can make a claim for Workers' Compensation benefits for the CRPS. However, because the cause of this chronic condition is not fully understood, most employers (and their insurance carriers) will deny the claim.

"There are pain management physicians that specialize in both the diagnosis and treatment of CRPS," explains Adam Dombchik, managing partner in the law firm of Gordon, Edelstein, Krepack, Grant, Felton & Goldstein, LLP (GEKLAW). "In these cases we recognize the urgency to have a client with this condition evaluated by either a treating pain management physician, or evaluated by a medical legal evaluator (agreed or panel qualified medical examiner)."

By understanding the neurological and psychological impact of this condition on one's daily life, early intervention treatment can make a significant difference in the recovery outcome. 

Documentation is Key

It is also important for an injured worker suffering from CRPS to document all medical tests that have been conducted as well as the treatment history. This can help create an objective outline of what many insurance carriers see as a subjective condition (i.e., the injured person is a malingerer or has a secondary gain in mind).

Further, documentation will insure that application of the American Medical Association Guidelines, 5th Edition (AMA Guides), which is used to evaluate loss of overall body function, will be properly applied to secure the most accurate disability rating for an injured worker suffering from CRPS. 

The Workers' Compensation attorneys at GEKLAW have more than three decades of experience fighting for the rights of injured workers, going above and beyond to gain the medical treatment and other benefits their clients need to help ensure a brighter future for themselves and their families. If you would like to learn more about your legal options, click here or call 213-739-7000.