CRPS Compensation

It is caused by an injury to the ‘sympathetic nerves’ and is typically characterised by intense burning pain, increased skin sensitivity, changes in skin colour and temperature and abnormal nail and hair growth. The areas affected are most often the arms, hands, legs and feet, but it can affect many other areas of the body.

As a result, in 2019, the IASP CRPS Special Interest Group convened a workshop in Valencia “to review perceived ambiguities in the diagnostic text and issues identified in applying these criteria in both the research and clinical contexts.”

The Valencia consensus-based adaptation deliberately avoids altering the wording of the original diagnostic criteria so as not to invalidate them. Full details of the adaptation can be found in our related article. In summary, however, the new classification is:

Chronic Primary Pain

Chronic Primary Pain is the new parent classification.

CRPS II

Is a sub-type that was previously associated with discrete peripheral nerve damage only. However, this diagnosis now requires more than an identified nerve injury, including neuropathic pain, paraesthesias, numbness, or autonomic dysfunction, albeit restricted to the territory of the nerve lesion.

CRPS with Remission of Some Features

This is an entirely new sub-type introduced to describe people who previously fully met the diagnostic criteria for CRPS I or CRPS II, but who currently display insufficient features to meet those criteria.

CRPS NOS (Not otherwise specified)

A sub-type for those who have never been able to fulfil the new IASP CRPS criteria.

Many people exhibit severe symptoms immediately, whilst in others the onset is far more gradual. Also, not every CRPS sufferer experiences all of these symptoms. Accordingly, an attempt to divide the onset of symptoms into stages can be artificial and misleading. However, historically, the onset was categorised as follows:

Stage One CRPS (The Acute Stage)

Typically lasting from one to three months and characterised by:

• Changes to the skin – typically a change in tone and feel, often becoming shiny with additional sweating.
• Changes in circulation can lead to a variation in skin colour, ranging from black to purple, blue or even white and some people report blotches or spots.
• Temperature change in the affected limb, changing between warm and cold for no discernible reason. It is at this stage that sufferers often hear the term ‘Warm/Hot CRPS’ and ‘Cold CRPS’. The former is used to describe limbs that feel considerably warmer than other parts of the body, but as CRPS progresses, this then gives way to the chronic phase when the affected limb will experience ‘Cold CRPS’.
• Severe burning pain in the affected limb which worsens at the slightest touch.
• The rapid growth of hair and / or nails on the affected limb.
• Swelling / joint pain and muscle spasms.

Stage Two CRPS (The Dystrophic Stage)

Common at between three to six months and characterised by:

• Worsening levels of pain which by then has usually spread from the initial area.
• Weakened muscles and stiff joints.
• Thinning or wrinkling which can turn a bluish colour due to a lack of oxygen in the blood or poor circulation.
• Cracking of the nails.
• A slowing of the previously rapid hair growth.

Stage Three CRPS (The Atrophic Stage)

This is said to be the start of the condition becoming entrenched and irreversible. It is characterised by:

• Constant and largely unvarying pain in the entire limb, with muscle wasting;
• Limited movement throughout the limb as a result of tightened muscles and tendons.

Whilst early treatment is best, even following a very late diagnosis, treatment can still be of benefit to some people at Stage Three.

As leading CRPS Solicitors, we often encounter new clients who have already reached the Atrophic Stage. Sadly, even with greater awareness of CRPS among clinicians, in many cases there remains a failure to diagnose the condition at an early stage.

Stage Four CRPS

Some but not all doctors refer to Stage Four CRPS where the condition has become resistant to treatment and where internal organs are affected. Most CRPS sufferers will never reach this stage.

Medical Imaging

Medical imaging such as MRI scans and x-rays can discount an underlying structural cause and blood tests can help to eliminate causes such as infections and arthritis.

Anaesthetic Block

An anaesthetic block administered to the sympathetic nervous system can help to diagnose CRPS as the cause, which can therefore assist with the compensation claim for CRPS.

Physical Examination

A physical examination can reveal changes to the skin, abnormal hair growth, changes to finger or toe nails and the presence of swelling. Some doctors are now using thermographic cameras to compare the heat between limbs and ultraviolet cameras to better see the mottling of the skin. Clearly, some of these changes are subtle and the use of technology in diagnosis is likely to become increasingly important.

Delayed Diagnosis

Of course, the difficulty in diagnosing CRPS can invariably lead to delay. However, despite a growing awareness of CRPS among clinicians, that delay is often lengthy. In fact, the vast majority of our clients start their claims with other law firms before approaching us for more specialist representation. The reality is that it can often be between several months and two or more years before we are approached to take over conduct of the claim. With that in mind, we find it quite staggering at the number of our new clients who have either only recently received a diagnosis of CRPS or are still awaiting a formal diagnosis.

The common delay in diagnosing CRPS means that treatments that may have proved beneficial early on, may be of less benefit once the condition has become established.

Please check out our Blog where we frequently post articles looking at the latest developments in treatment for CRPS. As CRPS Solicitors, we are often among the first to report on important developments, and we can often arrange funding for treatment as part of your CRPS compensation claim.

Medication

Medication is effective in less than two-thirds of sufferers.

Achieving the right balance of medication can often prove difficult. Very broadly speaking, the stronger the painkilling effect of the medication, the greater side effects it will have, particularly mentally. This makes it even more difficult to function on a daily basis. The pain may be less, but tiredness, lack of concentration, poor memory and reaction time, may be the price to pay.

• Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) – often the starting point prior to diagnosis, NSAIDs are unlikely to have any effect upon pain caused by CRPS.
• Anticonvulsants – whilst anticonvulsant drugs such as Pregabalin and Gabapentin are commonly used to treat epilepsy, they are also prescribed for serious neuropathic pain. However, clients often report to us major cognitive side effects. One described feeling “like a zombie. I was no use to anyone.”
• Tricyclic Antidepressants – Amitriptyline or Nortriptyline are often prescribed to chronic pain sufferers as they have been found to be helpful for nerve pain. One side effect, or as some clients have described it “a side benefit”, is that it also aids sleep.
• Opiates – Some chronic pain sufferers are prescribed Buprenorphine (which is similar to Morphine) as skin patches, or even Morphine itself, usually as Oramorph solution.

Sympathetic Nerve Blocks

Some CRPS sufferers gain temporary pain relief from sympathetic nerve blocks. There is, however, no evidence that nerve blocks can provide long term benefit.

The procedure involves an injection of anaesthetic next to the spine to both interrupt the activity of the sympathetic nerves and to improve blood flow.

Physical Therapies

Physical therapies are more generally utilised as part of a multi-disciplinary pain management programme. The techniques used may include gentle exercise and weight-bearing, as well as hydrotherapy.

A commonly used technique is Desensitisation, which is designed to reduce sensitivity by focusing on how different materials feel against unaffected parts of the body.

Self-Management

Relaxation techniques and guidance on pacing yourself are skills which are very useful on a daily basis. Occupational therapists are often brought in to help CRPS sufferers develop these skills.

Graded Motor Imagery / Mirror Box Therapy

This is one of the oldest treatments used for CRPS. Although Graded Motor Imagery encompasses a number of techniques, perhaps the best known is Mirror Box Therapy. The equipment is simple, comprising a box and a specially placed mirror. Using the unaffected limb, the idea is to trick the person’s brain into thinking that the symptoms of CRPS have disappeared.

Pain Management Programmes

The idea behind pain management is to turn existing with chronic pain into living with chronic pain.

There is no one universal approach offered by pain management programmes, who instead have at their disposal a wide range of treatments and multi-disciplinary support, which to a certain degree they can use to tailor therapy to the individual. Whilst a programme will usually be coordinated by a consultant in pain medicine, the patient will also receive input from physiotherapists, occupational therapists and psychologists.

As they cannot ‘cure’ the patient’s pain, the role of the pain clinic is best summarised as supporting a patient in developing self-help skills to control and relieve their pain. It is hoped that through these coping strategies, the patient will experience an overall improvement in their quality of life.

Most large hospitals run pain management programmes. In addition to the more common outpatient approach, a few centres are equipped to offer inpatient programmes. The advantage of inpatient pain management is that for a limited period, usually between two and four weeks, both the patient and the multi-disciplinary team are focused entirely on working together to develop coping strategies. This is often more difficult and therefore less successful when attending as an outpatient once a week over the course of a number of weeks or months.

As specialist CRPS solicitors, BLB Solicitors have been hugely successful in arranging funding for clients to attend these residential programmes during their CRPS compensation claim. It is also important to be conscious of the potential for ‘crash and burn‘ following attendance on such a programme.

Spinal Cord Stimulation

For some chronic pain conditions, the implantation of a spinal cord stimulator (SCS) or a dorsal root ganglion stimulator (DRG) can help to provide long term pain relief.

The procedure is invasive, as it involves the insertion of electrodes close to the spinal cord. These are connected to a battery-powered device that is implanted under the skin and controlled externally by remote control. These devices deliver electronic signals which, it is hoped, will interrupt the pain signals to the brain.

Many of our clients have undergone the procedure. Whilst all have reported a reduction in levels of pain, the degree of pain relief experienced has varied considerably.

Alternative Therapies

Some sufferers find alternative therapies effective for short term relief of their symptoms, particularly therapies aimed at relaxation. Yoga, meditation, assistance dogs, acupuncture and gentle, low-impact exercise are particular popular. However, people suffering CRPS should be wary of those seeking to take advantage of their desperation.

Medical Trials

The large number of people suffering chronic pain means that there is a lot of ongoing research into new forms of treatment, good current examples being those for Neridronate and sensorimotor training.

Whilst medical trials are outside of the scope of their claims, several of our clients have been selected to take part in medical trials, sometimes with encouraging results.

Indeed, where the condition has become entrenched, we have also successfully arranged funding for many of our clients to undergo spinal cord stimulation (SCS) or dorsal root ganglion stimulation (DRG).

In summary, what you can expect when you instruct us is:

• access to the leading experts in the field to get you the specialist medical help you so desperately need;
• regular requests for early interim payments to fund the cost of recommended treatment and rehabilitation (for example, inpatient rehabilitation, hydrotherapy, physiotherapy, psychological therapy and spinal cord stimulation/dorsal root ganglion stimulation);
• consideration as to whether you would benefit from the appointment of a medically qualified case manager to coordinate your treatment, rehabilitation, purchase of specialist equipment and adaptations to your home.

While it may seem unusual these days, we are CPRS claim solicitors who do like to meet our clients! If travelling to see us is difficult, wherever you live, we may be able to see you at home or at another location more convenient for you, in order to discuss your CRPS compensation claim.