After the Accident: Complex Regional Pain Syndrome
After an accident or other physical trauma, pain from an injury can stick around for longer than it should. In some cases, this persistent pain can turn out to be complex regional pain syndrome, or CRPS. The pain that develops is usually much greater, proportionally, than would normally be anticipated from the initial injury.
We don’t know a lot about CRPS, and why it develops in some injury victims and not in others. But we do know that treatment is more effective if it is started without delay. Sometimes CRPS can even go into remission if treatment is begun early enough.
What is CRPS?
A chronic condition, CRPS appears most commonly in the extremities (arms, legs, hands, and feet) following an injury. It can begin at the location of the initial injury but spread to the entire limb. Of the two types of CRPS, Type I can occur after an injury in which no nerve damage is sustained. CRPS Type II can begin after a:
- Broken bone
- Serious infection
- Soft tissue injury such as a sprain, cut or burn
- Medical procedure or surgery.
With Type II, nerve damage is evident.
CRPS generally progresses in three stages. Stage 1 is characterized by changes in skin temperature, muscle spasms, pain, and stiffness. After the first 30 to 90 days of stage 1, stage 2 begins, with increased pain and swelling and decreased muscle tone. Stage 2 usually lasts from 3 to 6 months. With stage 3, changes become irreversible, often with severe mobility limitations, loss of bone density, and muscular wasting.
While doctors are not sure why it appears only in some people, the evidence shows that CRPS is not “just in your head.” CRPS is a real pain condition and is defined as a medical disability by the Social Security Administration. Some doctors, insurers, and others can insist that CRPS is imaginary, which can create problems for those who suffer from it.
Symptoms and Diagnosis of CRPS
It can be difficult to diagnose CRPS, but one of its hallmarks is pain that continues to grow worse after an injury or trauma. Additionally, the following symptoms are often seen:
- Pain that is often described as burning, “cold,” deep-set (such as in the bone), or aching
- Increased skin sensitivity, especially to cold and to touch, but also to things that should not cause pain, such as clothing or taking a shower
- Unusual swelling in the affected area
- Changes in skin coloration, such as skin turning mottled, white, red, or blue
- Changes in skin texture, such as becoming thickened or shin
- Unusual growth of hair or nails
- Joint stiffness and swelling
- Abnormal skin temperature and unusual sweating in the painful area
- Weakness, limited range of motion, or paralysis.
No single test exists to confirm a diagnosis of CRPS. However, a number of procedures can provide clues, including bone scans to detect bone changes, and sympathetic nervous system tests, such as procedures that measure the temperature, blood flow, and amount of sweat on affected and unaffected limbs. Sometimes MRIs can detect soft tissue changes, and X-rays (in the later stages of CRPS) can disclose mineral loss in bones. Because diagnosis can be tricky, you may need to visit more than one doctor in order to obtain the treatment that will bring you relief.
How is CRPS Treated?
While no cure exists, a number of therapies can ease pain and keep blood moving in the affected area:
- Rehabilitation, such as exercise programs and occupational therapies.
- Medications such as anti-inflammatories (NSAIDs), corticosteroids, and those that treat neuropathic pain such as gabapentin and pregabalin. Topical treatments such as lidocaine and botulinum toxin injections can help. No one drug helps everyone; there is a wide array of choices.
- Sympathetic nerve block, which can be temporary or permanent (surgical). The temporary block involves injecting an anesthetic next to the spinal column. The surgical option can be controversial and is not always tried.
- Spinal cord stimulation and neural stimulation involving implanted electrodes.
- Intrathecal drug pumps that push pain-relieving drugs directly into the spinal fluid.
- Psychotherapy to deal with the profound changes that CRPS can bring to its sufferers and their families.
If you think you might have CRPS, or have been diagnosed with CRPS, there are support groups in Maryland than can help. If your CRPS began after injuries sustained in a crash, you might want to consider consulting an attorney.
We’re Listening. How Can We Help You?
Sometimes injuries from a car accident appear to heal. But when a pain syndrome is the lingering result of a crash, each day is a trial and your future can feel full of insecurity. Returning to work may not be possible, and ongoing medical costs may exhaust both your bank account and your spirit.
At the Law Offices of Steven H. Heisler, we understand how challenging the aftermath of a car accident can be for both the injured person and for his or her family. In our work to help car crash victims recover compensation from drunk drivers and other parties at fault in motor vehicle accidents, we’ve become aware of the complexity of issues surrounding pain syndromes in Maryland.
If you or a family member has been the victim of an injury caused by a motor vehicle accident, call Baltimore personal injury attorney Steve Heisler. Keep in mind, however, that there is a statute of limitations – or a time limit – for filing personal injury claims. If you have been injured in an accident or have otherwise incurred a personal injury, you should not delay. Contact the Law Offices of Steven H. Heisler of Baltimore, Maryland, for a free and confidential initial consultation by calling (410) 625-4878 today. If you prefer, use our convenient online form.
$5,500,000.00 - Steve represented a 33-year-old single mother of one whose vehicle was struck head-on by a construction truck in 2002. The client suffered life threatening injuries and was in a coma for six weeks. She required two months of brain injury rehabilitation. The client currently has serious permanent disabilities as a result of the accident including short term memory loss, impaired speech, double vision, and right side paralysis.
She is unable to return to her occupation as a dental hygienist or any other occupation. Steve Heisler and his associate Keith Kauffman negotiated a $5.5 million structured settlement at mediation. Should the client reach her life expectancy the payout increases to $9.5 million.
$250,000 - Steve represented the family of a 15 year old Anne Arundel County boy who was killed when the vehicle he was a passenger in failed to negotiate a curve and struck a tree. The defendant driver was also killed. Another passenger survived the crash. The defendant driver had a $300,000.00 liability policy. Steve negotiated a $250,000.00 settlement for the family. The remaining $50,000.00 was tendered to the surviving passenger.
$800,000 - Steve represented the estate and family of a 45 year old man who was killed when the motorcycle he was riding struck a guardrail and he was catapulted down an embankment. The estate and family alleged that a vehicle in the lane to the immediate left of the man swerved into his lane and caused a collision. The defendant strongly denied any wrong doing. The case was settled at a settlement conference for $800,000.00.
$325,000 - Steve’s client, a 45 year old Sr. Program Manager, was struck by a work vehicle that failed to yield the right of way while turning left in front of the victim in St. Mary’s County, Maryland. Steve’s client was thrown from his Harley Davidson and suffered multiple injuries resulting in two surgeries. Suit was filed and the case settled for $325,000.00.
$200,000 - Steve’s client, an elderly lady from West Virginia, was seriously injured when the car she was traveling in was struck by a negligent driver in Garrett County, Maryland. The lady suffered a broken back and detached retina. Steve negotiated a $100,000.00 settlement with the defendant driver’s insurance company and was successful in getting his client’s West Virginia insurance company to “stack” an additional $100,000.00 for a total settlement of $200,000.00.
$100,000 - Steve represented a five year old Eastern Shore boy who was struck by a vehicle driving on the wrong side of the road while the boy was riding his bike. Steve's client suffered a traumatic brain injury and serious fractures which required him to spend an extended period of time in a rehabilitation center. The boy now has permanent brain damage. The case settled for the driver's policy limits of $100,000.00.
$95,000 - Steve represented a 36-year-old Cecil County man who was rear ended while stopped at a red light. The force of the impact was severe and his client’s vehicle was totaled. Steve’s client suffered a cerebral concussion, a C5-6 disc herniation, and a L2-3 disc protrusion. He received a 30% whole-body permanent disability rating. Steve settled the case with the insurance company for $95,000.00.