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Hiding in Plain Sight: Reflex Sympathetic Dystrophy/Complex Regional Pain Syndrome



At times, severe pain suffered after an injury may seem out of proportion to the injury itself or underlying diagnosis. When this occurs in litigation, defense lawyers will usually claim that the victim is simply making up the pain to inflate his/her claim. But a serious underlying condition is the possible culprit. RSD (reflex sympathetic dystrophy) and CRPS (complex regional pain syndrome) are synonymous terms for a rare, often undiagnosed, condition that physicians have been reporting on since around 1865. About 200,000 individuals a year experience this condition in the United States. CRPS/RSD can be the result of a serious injury but in many cases, CRPS results from a relatively minor injury. The diagnosis is often made when the pain experienced is disproportionate to the level of injury.


What is CRPS/RSD?


CRPS/RSD is a chronic neuro-inflammatory disorder. CRPS/RSD occurs when the nervous system and the immune system malfunction as they respond to tissue damage from trauma. The nerves misfire, sending constant pain signals to the brain. The level of pain is measured as one of the most severe on the McGill University Pain Scale.


CRPS generally follows a musculoskeletal injury, a nerve injury, surgery or immobilization – all common injuries in automobile wrecks, trucking wrecks, motorcycle and bicycle wrecks and trip and falls. Although insurance company lawyers suggest that people with CRPS/RSD exaggerate their pain to inflate their claims, medical research has proven that the condition is a known, diagnosable physical disorder. Further, medical research has shown that the persistent pain and disability associated with CRPS/RSD require coordinated, interdisciplinary, patient-centered care to achieve pain reduction/cessation and better function. It has been shown that early diagnosis is generally the key to better outcomes.


In those cases where the victim continues to suffer real, disproportionate and severe pain following reasonable treatment, diagnosing “why” is critical. Because it is a rare condition, diagnosing CRPS/RSD is often not considered. But without the diagnosis, it is difficult to present that severe and continued pain to insurance adjusters and defense lawyers as simply a “new normal” and obtain full compensation for the injury. Where the symptoms persist, RSD should always be considered for effective treatment of the victim and to ensure fair compensation for the injury. Fried Bonder White lawyers have experience with injury victims who suffer from CRPS/RSD.


How to Diagnose CRPS/RSD


There is no single diagnostic tool for CRPS/RSD. Physicians diagnose it based on patient history, clinical examination, and laboratory results. And in order to properly get there, treating physicians must rule out any other possible conditions that would otherwise account for the degree of pain and dysfunction before considering CRPS/RSD.


Look for CRPS/RSD Signs and Symptoms


There is no single checklist – this is why it takes work to determine if a victim is suffering from CRPS. But consider - if the pain is getting worse, not better, and if the pain is more severe than one would expect from the original injury, it might be CRPS/RSD.


Here are some symptoms to take note of if you or your client continues to suffer severe pain that seems out of line with the injury:

  • pain that is described as deep, aching, cold, burning;

  • increased skin sensitivity;

  • an initiating injury or traumatic event, such as a sprain, fracture, minor surgery, etc., that should not cause as severe pain as being experienced;

  • where pain does not subside with healing;

  • allodynia – which is pain from something that should not cause pain, like brushing up against furniture or a shower;

  • heightened sensitivity to painful stimulation;

  • abnormal swelling in the area of injury;

  • abnormal sweating of the affected area;

  • limited range of motion, weakness, or other motor disorders such as paralysis or dystonia.

CRPS/RSD is real, serious and can substantially affect an injured person’s ability to enjoy life. Because it is rare, it often goes undiagnosed in injury cases. It shouldn’t. Without a proper medical evaluation, not only does an undiagnosed victim lose out on available treatment, she also loses out on full and fair compensation for the injury. The lawyers at Fried Bonder White help their clients explore every avenue of injury – like CRPS/RSD and help them get the treatment they need to ensure that they recover both physically and financially.



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