What is Complex Regional Pain Syndrome?
Complex Regional Pain Syndrome (CRPS) (which is often misquoted as Chronic Regional Pain Syndrome) is a chronic pain condition which develops following trauma, and leads to severe, debilitating, persistent pain.
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 effect many other areas of the body.
The International Association for the Study of Pain (IASP) recognise three types of CRPS: CRPS Type I, CRPS Type II and CRPS NOS.
“It’s difficult to believe it’s over! My union solicitors were an utter joke but you’ve been unbelievable from start to finish. I’m so pleased I finally plucked up the courage to call you.” TW (£535,000 compensation recovered for CRPS), March 2018
See our CRPS Case Studies.
- Why do you need a specialist CRPS Solicitor?
- Types of CRPS
- CRPS in Children and Adolescents
- Symptoms of CRPS
- Diagnosis for CRPS
- Causes of CRPS
- Treatment for CRPS
- CRPS Compensation
- We are CRPS Specialists
- Support for CRPS
Why do you need a specialist CRPS Solicitor?
Over many years, we have worked with hundreds of clients with Complex Regional Pain Syndrome and through them have developed not only an unrivalled understanding of CRPS, but also excellent working relationships with many of the country’s leading medical experts in the condition. As CRPS Solicitors, this is knowledge and expertise we use daily for our clients’ benefit.
We understand the fundamental importance of seeking early specialist treatment and are regularly able to arrange funding for the complete range of treatment options including residential pain management/rehabilitation. Indeed, where the condition has become entrenched, and subject to a person’s suitability and personal choice, we have also successfully arranged funding for many of our clients to undergo spinal cord stimulation (SCS) and 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 treatment and rehabilitation as recommended by the medical experts (for example, inpatient rehabilitation, hydrotherapy, physiotherapy, psychological therapy and spinal cord stimulation/dorsal root ganglion stimulation);
- consideration as to whether you would benefit from a medically qualified case manager to co-ordinate your treatment, rehabilitation, purchase of specialist equipment and adaptations to your home.
“Following an accident at work I received a foot injury which left me with a condition called CRPS. The solicitors firm I had initially were beyond bad. The best thing I ever did was to speak to Andrew Atkinson at BLB. Not only is a really caring person, he really understands CRPS and helped to get me some private treatment that I know I would never have got on the NHS. I can’t thank him enough.” PB (£465,000 compensation recovered for CRPS), May 2018
What will happen when you call us?
One of our specialist CRPS solicitors will be waiting to speak with you. They will be able to talk through your situation and make a realistic assessment of how we can maximise your compensation and, crucially, help you to obtain the early, specialist treatment you need.
For information on CRPS, including the latest on research and treatment, please also keep an eye on our informative and regularly updated Blog.
Types of CRPS
There are two main forms of CRPS – CRPS Type 1 and CRPS Type 2, as well as CRPS (NOS).
The difference between CRPS Type 1 and CRPS Type 2
The difference between CRPS Type 1 and CRPS Type 2 is that in CRPS Type 1 there is no direct damage to the peripheral nerves in the affected limb. In CRPS Type 2, there is identifiable nerve damage.
As CRPS Type 2 is caused by an injury to the peripheral nerves, unlike CRPS Type 1, the pain and other symptoms do not spread beyond the original injury site.
Complex Regional Pain Syndrome Type 1
CRPS Type 1 is a chronic or persistent pain condition which usually appears in one area of one limb, but can then spread elsewhere in that limb or to other parts of the body. It invariably appears in an area which has been subject to injury.
About 90% of people suffering CRPS are diagnosed with CRPS Type 1, which was formerly known as Reflexive Sympathetic Dystrophy (RSD).
The difference between CRPS Type 1 and CRPS Type 2 is that in Type 1 there is no identifiable damage to the nerves in the affected limb. In CRPS Type 2, there is identifiable nerve damage.
Symptoms of CRPS Type 1
Diagnosis of CRPS Type 1
The absence of nerve damage complicates the diagnosis of CRPS Type 1. In addition, there is often no bony injury and relatively modest damage to the soft tissues. Despite this, the pain of CRPS is out of all proportion to the injury. Indeed, CRPS is the most painful condition known to medical science.
Treatment of CRPS Type 1
Although there is no cure for CRPS, there are a variety of treatments and therapies which can often help the long term management of the condition, including reducing levels of pain.
Complex Regional Pain Syndrome Type 2
CRPS Type 2, formerly known as Causalgia, is much rarer than CRPS Type 1, affecting around 10% of those diagnosed with CRPS.
It is caused as a result of an injury to a peripheral nerve. Peripheral nerves link the limbs and organs to the central nervous system.
Symptoms of CRPS Type 2
The pain of CRPS Type 2 is intense, burning and unremitting pain in the area of the injury. Sufferers can also experience changes in hair and nail growth in the affected limb and joints in that area can spasm or even seize up. CRPS is the most painful condition known to medical science.
Treatment of CRPS Type 2
Although there is no cure for CRPS, there are a variety of treatments and therapies which can often help the long term management of the condition, including reducing levels of pain.
Complex Regional Pain Syndrome (Not Otherwise Specified) or CRPS (NOS)
More recently, in addition to Types 1 & 2, a third type of CRPS has been recognised – CRPS-NOS (Not Otherwise Specified).
CRPS (NOS) is a diagnostic label that can be attached when somebody only partially meets the diagnostic criteria of CRPS, but where no other diagnosis can be made.
CRPS in Children and Adolescents
Whilst Complex Regional Pain Syndrome is very rare in the elderly, children can develop the condition. It is virtually unheard of in babies and toddlers and rare under the age of ten, but there are regular examples of it occurring in teenagers.
Seeing anybody suffering the torment of CRPS can be distressing, but in a young person it is particularly heartbreaking.
CRPS in children and adolescents creates its very own set of problems, particularly in relation to the prescribing of stronger medications and consideration of the more invasive forms of treatment such as spinal cord stimulation (SCS) and dorsal root ganglion stimulation (DRG).
Symptoms of CRPS
The symptoms of CRPS can vary considerably over time and from person to person.
Whilst it is largely now considered to be bad practice to attempt to define CRPS in terms of stages, some doctors continue to do so. 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 (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 (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 (The Atrophic Stage)
This is the 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.
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.
“Your understanding of my condition was incredible. I immediately felt I was in safe hands and that proved to be true.” TF, November 2018 [£370,000 compensation recovered for CRPS]
Diagnosis for CRPS
Unfortunately, there is no single test for diagnosing CRPS. It is often as much about discounting other conditions as the cause of each and every symptom as it is about positively diagnosing the symptoms of CRPS.
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.
An anaesthetic block administered to the sympathetic nervous system can help to diagnose CRPS as the cause.
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.
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 three 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.
“What really stood out for me when we first spoke was your total concern for me and your interest in my condition. Thank you so much for steering me towards Dr _______. He has helped me so much.” JT, January 2018 [£415,000 compensation recovered for CRPS]
Although there is no specific test, for many years there have been diagnostic guidelines.
At their conference in 2004, the International Association for the Study of Pain (IASP) adopted a new set of guidelines for diagnosing CRPS, superseding guidelines which had been in place for the previous decade. As the conference took place in Budapest, the new guidelines were named the Budapest Criteria. More information on the Budapest Criteria for diagnosing CRPS is available here.
Causes of CRPS
The question that has puzzled scientists for over 150 years is ‘what causes complex regional pain syndrome’? Unfortunately, there is no accepted cause for CRPS. However, it is generally thought that it results from a malfunction in the central or peripheral nervous system, whereby the nerves are effectively ‘rewired’ so that they send the wrong signals to the brain.
Treatment for CRPS
Sadly, there is no cure for Complex Regional Pain Syndrome (CRPS). Whilst research suggests that 50% of sufferers will notice a very gradual improvement in their condition over the first couple of years after developing the condition, many notice no improvement at all or suffer a deterioration.
However, there are treatment guidelines for CRPS.
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.
“Thank you so much for everything. I couldn’t have hoped for a nicer, kinder and more understanding solicitor. Your confidence is infectious!” JW (£322,000 compensation recovered for CRPS), March 2018
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.
“Andrew, I feel so lucky to have found you. What a difference you made! Let’s face it, with [previous solicitors] the claim was heading for the rocks. Thank you so much.” TR (£430,000 compensation recovered for CRPS), October 2018
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.
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.
BLB Solicitors have been hugely successful in arranging funding for clients to attend these residential programmes. However, we are also conscious of the potential for ‘crash and burn‘ following attendance on such a programme.
Spinal Cord Stimulation
The procedure is invasive, as it involves the insertion of electrodes close to the spinal cord. These are connected to a battery powered device which is implanted under the skin and controlled externally by remote control. These devices delivers 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.
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.
“I was represented by Bruce Dyer who is absolutely excellent. It’s so reassuring when you finally find a solicitor who understands CRPS. A fantastic experience. Highly recommended.” RW (£385,000 compensation recovered for CRPS), September 2018
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.
Please monitor our Blog where we frequently highlight new medical trials seeking participants.
We are the leading solicitors for CRPS Compensation, regularly achieving awards in high six and even seven figures. So far we have recovered over £53 million in compensation for people suffering CRPS.
As experts in CRPS compensation claims we understand just how debilitating your condition is and the effect it has, not just on you, but on your family.
Most of our clients begin their claims with other law firms they see advertising in the media before becoming quickly disillusioned with their lack of knowledge and expertise in CRPS, which prompts them to seek out more specialist representation. Once settled, a claim cannot be reopened, so it is imperative that your solicitor has the necessary knowledge and expertise in CRPS to ensure that:
- you receive the very best treatment at the earliest opportunity; and
- your long term financial security is protected.
As one client told us, “BLB represented me, unlike my last solicitor who tried to process me through a sausage machine.” Speak today to one of our expert CRPS solicitors. We are confident that you will notice an immediate difference from your current solicitors.
We are CRPS specialists
Put simply, we understand CRPS.
- We understand the devastating effect that it has not only on the sufferer, but on their wider family.
- We understand the fundamental importance of early diagnosis and treatment.
- We understand the importance of keeping each client protected financially, both now and for the long term.
It is our unrivalled understanding of CRPS that has for many years made us the preferred choice for those who develop the condition following an accident and are seeking CRPS compensation. Indeed, we are often referred to as ‘the CRPS Solicitors’.
It is an acknowledgement of both our expertise and our outstanding level of service that we are instructed regularly by solicitors and barristers around the country in respect of their own claims and recommended by them to their family and friends.
We are also invited regularly to speak at conferences and other events around the country on the subject of CRPS and chronic pain in litigation. This has included speaking at the British Pain Society’s Annual Conference, the Cambridge Medico-Legal Pain Conference, doctors seminars and charity events.
“What a relief it was to find you! My last solicitors didn’t have a clue what they were talking about and I really don’t think they even believed me. I just got the feeling that they wanted the my claim settled as soon as possible, whatever the implications for me.” JK (£420,000 compensation recovered for CRPS), June 2018