Complex Regional Pain Syndrome (CRPS) is a poorly understood condition which affects around 1 in 3,800 people in the UK every year.
As a personal injury solicitor, I represent individuals who have suffered serious injury as a result of someone else’s negligence. I regularly represent individuals who have developed CRPS following some form of traumatic injury, whether that it a road traffic accident or an accident in the workplace.
Personal injury claims for injuries resulting in CRPS can be difficult and complex. It can take significant investigation to diagnose the injury itself, as many medical practitioners will exclude other conditions before making such a diagnosis. It is also important that good evidence is obtained to ensure that the CRPS can be attributed to the accident, rather than some other factor in the injured person’s life.
In this blog, I intend to set out what CRPS is, the difficulties in diagnosing CRPS, what difficulties a CRPS sufferer may come across in bringing a personal injury claim and how these difficulties can be overcome.
What is CRPS?
CRPS is a pain condition, which can occur where an individual has suffered some form of trauma. It usually affects one or more limbs, although the condition has been known to spread to other limbs.
CRPS can be categorised as Type I or Type II, depending upon whether or not there is nerve damage (Type II involving a lesion to a major nerve). Whilst this will not alter the treatment recommended, this may be important when considered as part of a personal injury claim.
There are various symptoms of the condition, including:
- intense pain, which is disproportionate to the injury suffered
- temperature changes to the affected limb (it may be very hot or very cold)
- altered sensation in the affected limb
- excess sweating and/or altered hair growth
- swollen or stiff limb, such that the individual is unable to use it effectively
There was a previous school of thought that CRPS was a psychosomatic condition. This means that the pain was caused by psychological factors. Research has now been undertaken to disprove this theory, however there remains a great deal of stigma surrounding the condition. There are occasions where a CRPS sufferer may be made to feel as though they are malingering or indeed that they are making it up. Guidance prepared by the Royal College of Physicians has been prepared to educate medical practitioners about this condition, in an effort to reduce this stigma.
Current thinking is that CRPS is caused by the body’s abnormal reaction to an injury. Where one individual will suffer an injury and go on to recover well, an individual with CRPS will not. The actual cause of CRPS is unknown.
How is CRPS diagnosed?
Diagnosis can be very difficult. The condition is poorly understood by medical practitioners and often, the diagnosis will only be made after other conditions have been excluded.
There is a ‘checklist’ which medical practitioners may use to diagnose the condition. If the individual satisfies two or more of the recognised symptoms then, providing there is no alternative diagnosis for their condition, they will likely meet the criteria for diagnosis. Unfortunately, as above, the criteria for CRPS are often only considered when the individual’s recovery has failed to proceed as expected leading to a delay in diagnosing the condition.
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This can cause a number of difficulties for the injured person, as it is understood that the earlier treatment can be given for CRPS, the better. Treatment should be provided in a co-ordinated, multi-disciplinary way, to give the injured person the best chance of recovery. If treatment is delayed, there is a risk that the condition can become deeply entrenched and improvement is then unlikely. Further, it is also understood that living with an undiagnosed chronic pain condition can lead to psychological harm as a result.
Difficulties in bringing a claim for compensation – how we can help you to overcome these difficulties
There are a number of difficulties which a CRPS sufferer can face in bringing a claim for compensation. The condition can be incredibly debilitating, preventing an individual from working. It can also be very difficult for that person to engage with the litigation process, as they may have mobility difficulties and therefore struggle to attend appointments. They may also suffer from difficulties with concentration and fatigue, due to the pain they are suffering.
As a personal injury solicitor representing CRPS sufferers, I try to assist my clients in this respect by arranging appointments at home (where possible), encouraging the use of taxis, if appropriate, to limit the amount of time they spend travelling and arranging to speak with my clients at a time that is best for them (for example, some of my clients prefer to speak in the mornings when they are more alert).
I have set out below other difficulties which a CRPS sufferer may encounter as part of a personal injury claim, and the way in which these can be overcome.
The condition itself is poorly understood. It is very important that the right experts are chosen to examine the injured person and prepare a report. They must have a good knowledge of CRPS and the consequences of the condition, if they are to prepare a detailed and accurate report. There is a risk that if an expert is chosen who does not have the requisite skill, that the condition will not be reported correctly. This could have a significant impact upon the value of the claim.
At Bolt Burdon Kemp, we have a number of experts who we instruct who have a good knowledge of the condition and the treatment required. They are able to examine you and prepare a report, looking at the treatment which will be available to assist you in managing your condition.
Delay in diagnosis
CRPS can often be caused by a relatively minor injury. There are instances where the individual may not initially relate the CRPS to the original accident, as the accident may have been relatively minor. It is known that CRPS can follow a minor injury and so it is important that this is investigated.
When considering a claim for compensation, the claim must be brought within 3 years of the accident. Sometimes, an individual may not seek to bring the claim for the original injury as it is quite minor. It is not until they become more aware as to the likely consequences of the condition that they seek to bring the claim. There is a risk that this delay can make it more difficult to pursue the claim, particularly as cases involving CRPS are more complex.
Further, following a minor accident the claim may be brought by solicitors who do not specialise in this condition, and who deal with it as a straightforward claim. The orthopaedic expert may report that it is likely that the condition will resolve within a set period. This would be right for someone that is recovering from an orthopaedic injury, with no complications. Where someone has developed a pain condition like CRPS, they may actually deteriorate as time goes on, particularly if they are not given the right treatment. If the claim is settled quite quickly on the basis of such evidence, the injured person may not be aware of the full consequences of CRPS until after the claim has concluded. Any settlement will likely be full and final, and so they would not be able to return to the defendant for further compensation should their condition deteriorate.
It is therefore important that where someone is suffering from this condition, a specialist solicitor is instructed.
Despite work that has been done by the Royal College of Physicians to improve the stigma surrounding CRPS, a degree of stigma still remains.
Experts will often suggest that the individual is malingering, or making up their symptoms. They will also look at the previous medical history of the injured person, usually looking at psychological difficulties in their past which may make them psychologically vulnerable to develop the condition.
I see, all too often, reports prepared by experts instructed on behalf of a defendant, which look for psychological disorders in the injured person’s past as a way of showing a vulnerability to develop CRPS. It has been recognised that CRPS is not associated with a history of pain-preceding psychological problems or with somatisation (physical symptoms from a psychological cause). As a result, such arguments should be strongly resisted.
It is important that the right evidence is gathered from the start, to give the injured person the best chance of succeeding in their claim. This involves:
- Reviewing their medical records in detail
- Ensuring the injured person is seen by the right experts as soon as possible
- Ensuring that they are provided with the right treatment and rehabilitation as soon as possible to give them the best chance of managing their condition
- Preparing detailed witness evidence to demonstrate the impact of the injury on their day to day activities
It is important that when considering who to instruct to handle your personal injury claim, that you seek a specialist. A specialist solicitor will have access to the right individuals to assist you in your claim, including treatment providers, medical experts and other legal advisers such as barristers. A specialist solicitor will also have in depth knowledge of the condition, which ensures that they can combat allegations made by the defendant. They will also know the right questions to ask and which investigations to carry out to evidence your claim in the best way possible.
As a personal injury solicitor representing sufferers of CRPS, I understand how a relatively minor accident can lead to such debilitating consequences for a person’s life. I consider that my role is to guide the individual through what can be a difficult process, and to fight for that individual, to help them achieve the right amount of compensation which will assist them in managing their condition, as far as is possible, and achieving the best quality of life they can.