Also known as Reflex Sympathetic Dystrophy (RSD), Complex Regional Pain Syndrome (CRPS) is caused by an injury to the sympathetic nerves, resulting in severe pain. The condition can be catastrophic, permanent, and disabling.
There is no known cure for CRPS, although it is said that about 50% of patients can get better spontaneously. As leading CRPS lawyers, we specialize in many CRPS cases, working on behalf of our clients to get them the CRPS compensation they’re owed.
Personal injury claims involving CRPS can often attract a large sum in compensation. Personal injury compensation is calculated based on the severity of the injury and the impact it has on the individual’s life, meaning the value of the claim can vary greatly from one case to another, from less than £500k to more than £4 million.
The injury aspect is compensated with an award for pain, suffering and loss of amenity (PSLA). The guideline for this has been set by the Judicial College. The other aspects of the damages award is compensation for financial losses and expenses that occur due to the negligence, which can include loss of earnings, aids and equipment and medical treatment and care.
The reason why CRPS claims can vary so much for person to person is due to the fact that each of these heads of claims are calculated on a case-by-case basis. For example, a younger person in a high-paying job, who will be unable to ever return to work and require hours of care due to negligence, will receive a high award of damages as their life has been impacted significantly for a long period. However, someone who is close to retirement in a low-paying job, where the negligence will impact a shorter time frame, will receive a lower award of damages for the same injury.
Complex Regional Pain Syndrome, (formerly known as Begum Syndrome and also Reflex Sympathetic Dystrophy), is a chronic and progressive condition which effects many people around the UK and across the world. The condition, often abbreviated to CRPS is characterised by complex regional pain and in most instances it is triggered by an injury and the pain felt is out of proportion with the injury.
Complex pain syndrome usually affects a single limb but sometimes spreads into other parts of the body. It can affect every part of the limb in question from the skin to the joints and often CRPS syndrome manifests in feeling extreme pain even when the slightest touch or movement is felt.
The CRPS UK doctors treat is often caused by traumatic incidents such as car accidents or slips, trips and falls, with the resulting injury developing into CRPS or related pain syndrome conditions for no known reason.
The definition of CRPS has changed regularly through the years and there are now two separate recognised types:
Type I – often known as reflex sympathetic dystrophy and shows no evidence of nerve lesions
Type II – often known as causalgia and has clear evidence of nerve lesions and damage
Complex Regional Pain Syndrome Symptoms and Outlook
Complex regional pain syndrome can cause a wide range of symptoms and lead to a loss of mobility and many things which make getting on with day to day life quite difficult. Doctors may carry out a wide range of tests before you receive a diagnosis of CRPS but in the end, having the right diagnosis leads to the right treatment.
The outlook for people living with CRPS is changeable and entirely dependent upon the individual case, as no two cases are the same. Some people find the condition settles within a number of weeks whilst others have to accept it is a lifelong syndrome and something they will learn to live with. The treatment programmes for CRPS also vary greatly and often include pain relief, physiotherapy and self-management and lifestyle changes. Some individuals may also require psychological support which many doctors will make a referral for.
Complex Regional Pain Syndrome (CRPS) is a chronic condition which causes pain and other life-changing symptoms. CRPS usually affects a person’s limbs, such as an arm or a leg, and usually develops after a trauma such as a stroke, car accident or an injury. CRPS symptoms are not the same in every case, and though there are some similarities felt by some sufferers, it is entirely possible to meet someone else living with CRPS who have none of the same symptoms as you.
CRPS is a chronic condition that is typically triggered by a traumatic injury to a limb, but the pain does not subside as would usually happen during a usual recovery. Those suffering from CRPS tend to experience pain that is greatly amplified and disproportionate to the severity of the injury itself.
There are two different kinds of CRPS. Type 1, also known as Reflex Sympathetic Dystrophy Syndrome (RSDS), typically occurs after a minor or major tissue injury to a limb. According to the Mayo Clinic website, around 90% of CRPS sufferers have Type 1. Type 2 CRPS occurs after a distinct nerve injury, but unlike CRPS type 1, Type 2 does not migrate from the original site of the injury.
Anyone can develop CRPS following an accident or injury but it is unknown why some people go on to develop the condition following trauma while others will go on to make a full recovery. Many cases of CRPS occur after a forceful trauma to a limb from incidents such as road traffic accidents, but, more rarely, it can be caused by heart attacks, surgery and infections. The exact cause of the disorder is still unknown. It is thought to be caused by an injury or dysfunction in the central or peripheral nervous systems causing those suffering from CRPS to experience severe pain.
It is also believed by some that the symptoms are too complex to be as a result of one factor and that CRPS is caused by several different conditions. It has also been suggested that genes may play a role in who develops CRPS after an injury or trauma.
The characteristic symptom of CRPS is pain. Commonly described as a burning, intense pain specific to a single location on one of the body’s limbs, it is a pain which is out of proportion to the severity of the injury or the trauma which had occurred. CRPS pain is chronic, often getting worse over time rather than improving and often leads to the development of further symptoms. The symptoms and their severity vary from person to person and may change.
Some of the common symptoms include:
The symptoms that usually occur first are pain, swelling, changes in temperature and hypersensitivity. The condition is irreversible and may spread to other limbs in the body, but, with a combination of medicine and other treatments, most people experience a reduction in their pain within a few years.
Sometimes, although rarely, CRPS can cause complications, including ulcers and skin infections, muscle atrophy and muscle contractures in which the muscles shorten causing loss of movement.
These are the most common symptoms experienced by people suffering from CRPS, but it is essential that you seek medical advice rather than making a self-diagnosis. A medical professional can carry out the assessments and tests required to ensure the symptoms you are experiencing are indicative of CRPS.
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Complex Regional Pain Syndrome (CRPS) is a lifelong condition which is known for being very hard to diagnose, as there is no single test which can be carried out to give you a yes or no answer. CRPS diagnosis is mainly based upon the symptoms which you present, the results of a full physical examination and a number of different tests which may be carried out and which can give a clearer picture of the type of pain you’re suffering from and whether there is any other underlying cause for it.
Below are just some of the tests which may be carried out if your doctor suspects you may have CRPS:
Blood tests: carrying out blood tests can discover whether you have an underlying infection causing the pain or rheumatoid arthritis.
An X-Ray: an x-ray or bone scan on the affected limb can show any problems of bone thinning (osteoporosis) or any other abnormalities with the bones and joints.
MRI scan: used to find if there are any other underlying problems with your bones or tissue.
Nerve conduction studies: doctors may carry out tests which involve blocking the sympathetic nervous system with an anaesthetic. If they find that blocking this system relieves the pain, then they know they can focus in on it as the cause of the pain.
Not all doctors will carry out every single one of these tests and not all of them are necessary to receive a CRPS diagnosis but it is best to be prepared for as many tests as possible, to guarantee you get the results that you need to start upon the right treatment plan.
After CRPS Diagnosis
Once your doctor has diagnosed you with CRPS the next step is usually a referral to your local specialist pain clinic and the majority of these are found inside local hospitals. As soon as you receive your diagnosis your doctor should refer you on so you can begin to get the treatment you need and see a downward change in the pain you are suffering.
Most doctors and specialists in CRPS have accepted that is usually has three main stages, although it isn’t a condition which is systematic and not all of the stages may be followed or experienced by each individual. Some people develop severe symptoms straight away whereas others may never experience the later stages. Here is a closer look at the three CRPS stages that the condition may manifest into.
Stage one sees changes which last one to three months and is characterised through:
Changes to the temperature of skin – switching between warm and cold for no discernible reason
Severe burning, aching pain in the affected area which worsens when touched in the slightest way
Join pain or swelling
Rapid growth of nails or hair
Blotches or changes to skin tone and feel including shininess, additional perspiration and thinness.
Stage two generally sees changes which last from 3 to 6 months and is characterised through:
Slower hair growth
Increasing pain which continues to worsen
Cracked and easily broken nails
Stage three is the beginning of changes which are irreversible and need dedicated pain management and include:
Constant or near constant pain in the entire limb
Limited movement in the limb due to the tightened muscles and tendons
The progress through these stages is not necessary sequential, as previously mentioned and there is nothing to say individuals won’t experience one of the stages and go through another. There is also no research to suggest which CRPS stages may be experienced by each individual dependent on the cause of their condition.
CRPS remains a difficult condition to manage as there is so much unknown and it can take some time to get to diagnosis. The condition also has no cure so it is a case of managing the symptoms and living with the syndrome in the best possible way. Treatment is dependent on the individual situation and symptoms and many doctors will refer their patients not only for physical and medicinal treatment but psychological too.
Complex Regional Pain Syndrome is a chronic pain condition which, since first being discovered, has been split into two further types. It’s a condition which usually effects an area of a single limb but it can spread and it is usually related to a trauma or injury in the area where the pain is coming from.
CRPS comes in two forms referred to commonly as CRPS Type 1 and CRPS Type 2. CRPS Type 1 was formerly known as Reflexive Sympathetic Dystrophy Syndrome or RSD, although most people, especially medical professionals will now call RSD CRPS as this is the universally accepted term.
According to Mayo Clinic 90% of all sufferers of CRPS are diagnosed with CRPS Type 1 and is it different from Type 2 as it occurs after an illness or injury that didn’t cause any direct damage to the nerves in the affected limb.
Diagnosing CRPS Type 1 is particularly difficult as there is no damage to the nerves and usually no damage to the bone and little damage to the tissue. The pain is out of proportion to the accident or injury that occurred and the main symptoms are usually allodynia, continuing pain, and hyperalgesia, disproportionate pain to touch, movement or pressure.
CRPS Type 1 is usually diagnosed if the above symptoms are found as well as some kind of oedema, changes to the blood flow (and therefore temperature) in the affected area and other conditions have been ruled out.
Testing for CRPS Type 1 includes a wide range of scans and tests which doctors can organise, most of which are used to rule out other conditions to reach a diagnosis of this syndrome. Blood tests, MRI scans and further examination including nerve conditioning testing maybe organised and carried out before a diagnosis is made.
Once you have received a diagnosis of CRPS Type 1 your doctor will usually organise a specific course of pain relief and refer you to the pain clinic, usually held at your local hospital, where a full treatment plan can be organised to help you manage your condition and help alleviate the symptoms.
Complex Regional Pain Syndrome Type 2 is the rarer of the two conditions known as CRPS. CRPS Type 2, formerly known as causalgia, is a severely painful and chronic condition which develops as a result of an injury to a peripheral nerve. The pain associated with CRPS Type 2 is usually described as an intense burning which doesn’t subside and the pain is specific to the affected area, due to the injury to the nerve.
Differences to Type 1
CRPS Type 2 is different to Type 1 because of the tangible nerve injury which can be found and also because the pain doesn’t migrate from the original site. Whilst Type 1 may result in pain in the whole limb over time, CRPS Type 2 is a condition which remains specific to the original place that was injured.
CRPS Type 2 is caused by a trauma to a large nerve in one of the limbs, usually in the peripheral nervous system. CRPS Type 2 can be caused by a simple injury or something more traumatic such as a car accident or a fall from height. The disease progresses over time and can result in loss of movement and mobility in the effected limb, alongside increased pain. CRPS Type 2 pain is known to become resistant to painkillers over time.
The symptoms of CRPS Type 2 are quite similar to those of CRPS Type 1 which is why full diagnosis needs to be carried out by your doctor who may refer you to further specialists to ascertain the exact root cause of the pain. Symptoms of CRPS Type 2 include the burning pain already mentioned as well as sweating, discolouration to the skin in the affected area and hyperalgesia, extreme pain felt from disproportionate action such as light touch, pressure or movement.
CRPS Type 2 can also change the rate at which hair and nails grow and it’s also more common that the joints in the affected area may seize up or spasm.
There are no specific tests for CRPS Type 2 and like Type 1 it is mainly diagnosed through symptoms, by professional doctors and specialists who may carry out a range of tests such as MRI scans and blood tests, to rule out other conditions rather than pinpoint CRPS. If you have any concerns about on-going pain after an injury, contact your GP.
Managing CRPS pain is a case of bringing together a range of different treatments, lifestyle changes and personal exercises to help your condition feel manageable and not all-encompassing. Treatment for CRPS may involve a large care team or simply a couple of specialists.
Treatment for CRPS includes self-management and lifestyle changes, physical rehabilitation, pain relief medication and psychological support and counselling.
CRPS pain management begins with pain relief, usually organised through your GP or the professional pain clinic at your hospital. Pain relief maybe in the form of NSAIDs, anticonvulsants or tricyclic antidepressants, both of which are known for their success in treating nerve pain or in more extreme cases opiates including morphine or codeine.
Pain relief is usually provided alongside physical rehabilitation which may be in the form of sessions with a physiotherapist or guidance from related professionals. A physiotherapist may set you specific exercises such as stretching or weight bearing and they may introduce the technique of desensitisation. This works through teaching your body how different textures and touches feel against non-painful parts of your body and then touching the same textures against the painful parts, focusing your energy on how it felt on the other parts of your body, training your mind to be desensitised to the pain. Another technique you may learn is mirror visual feedback.
Another key part of your pain management, recognised in the majority of medical pain management guidelines, including the NHS, is self-management. Learning techniques in your everyday life to manage the pain of CRPS can really help make a difference. Your doctor should advise you remain as active as possible and use the affected limb as much as you can, as well as learn how to pace yourself and get to know your body’s limits and where it is comfortable. You may also consider learning relaxation techniques to improve your sleep quality and rehabilitation techniques such as desensitisation can actually be continued and worked upon at home.
Managing CRPS Pain can also be much easier if you are able to access a local support group, something your local pain clinic or GP surgery may be able to help you with.
Complex regional pain syndrome (CRPS) is a poorly understood condition in which a person experiences persistent severe and debilitating pain.
It is difficult to estimate exactly how common CRPS is, as many cases may go undiagnosed or misdiagnosed. It can begin at any age, including childhood. This being said, however, the average age for symptoms to start is around 50-years-old, with 3 out of 4 sufferers reported to be women.
There is no known cure for CRPS, however, a combination of physical treatments, medication and psychological support can help to manage symptoms.
Some of the main treatments used to treat CRPS are outlined below.
There are several medicines available that can help treat CRPS, however, none of them are licensed for use in the UK. This means that these medicines may not have undergone clinical trials to see if they are effective and safe in treating CRPS specifically. However, these medications will have a licence to treat another condition and will have undergone clinical trials for this. Doctors may choose to use an unlicensed medication if it is effective and the benefits of treatment outweigh any risks. Some of the main pain relief treatments include:
Spinal cord stimulation
If medication fails to lessen pain, spinal cord stimulation may be recommended. This invasive procedure involves a battery-operated device being implanted under the skin on the stomach or buttocks and attached to electrodes placed close to nerves in the spine. The device produces mild electrical pulses that are sent to the spinal cord. The pulses change how pain is experienced; for example, a tingling sensation may be felt in the part of the body that usually hurts, which can mask pain. The level of stimulation can be adjusted as pain improves or gets worse, and the device removed if necessary.
Sympathetic nerve block
An injection of anaesthetic next to the spine can interrupt activity of the sympathetic nerve and increase blood flow. This can offer temporary pain relief, however, is not considered to have long-term benefits.
Mirror visual feedback and graded imagery
Performing certain movements can be difficult for CRPS sufferers as information needed by the brain is often missed or confused. Techniques, such as mirror visual feedback, mirror box therapy and graded motor imagery aim to improve movement by retraining or ‘tricking’ the brain into thinking symptoms have disappeared.
This involves relying on different treatments to enable CRPS sufferers to gradually increase activity and functionality without making the pain worse. Techniques include gentle movement, such as stretches in water (hydrotherapy) or light, weight-bearing exercises. Desensitisation is a commonly used technique focusing on how unaffected body parts feel when touched with various materials compared to affected areas. The process can be uncomfortable or painful initially, however, may eventually reduce sensitivity in the affected body part.
Due to the complex nature of CRPS, different health professionals will be involved in care pathways, such as a GP, physiotherapist, psychologist, occupational therapist and pain relief therapist. These specialists work individually or jointly on Pain Management Programmes (PMPs), usually based in local hospitals or clinics, and treatments can include such things as cognitive behavioural therapy (CBT).
There are many approaches aimed at helping CRPS sufferers to take more control of their own condition. These include:
*Please note, this information should not be taken as medical advice. Brian Barr Solicitors are not medical experts, therefore, this page is for information purposes only.
Brian Barr Wins £905,000 for CRPS Client.
Neil Swift developed Complex Regional Pain Syndrome following an accident at work.
Neil was working for a civil engineering company as an HGV driver. Returning to the company yard one day, he found a JCB was parked across and blocking the entrance. Under instruction from his manager, Neil went to move the JCB so that he could park his HGV in the yard. The JCB had been vandalised, including having its windows smashed. Neil climbed up the steps to the cab, but was unable to open the damaged door. Instead he tried to reach through the broken window to open the door from the inside. As he did so, he slipped, badly cutting his left arm on the remaining shards of glass.
As a result, Neil damaged the radial artery, median nerve and flexor tendons. He developed CRPS and underwent a median nerve block, Guanethidine blocks, physiotherapy, Pain Management, a Sympathectomy and nerve graft.
His left arm has been left virtully funtionless and though right handed, Neil has been unable to work since.
The company quickly admitted liability as they had exposed Neil to a risk of injury, however they argued that he should also accept partial responsibility as he should not have put his arm through the broken window. This is a fair argument, however they were initially looking for a discount of 25%, which we negotiated down to 15%.
It was a dificult time for Neil, his wife and two young children. The unrelenting pain meant that his role as father and husband was tough, as he wasn’t able to work, or do very much at all. However he and his wife battled through, and now with the prospect of financial security for the future, life will start to pick up again.
There are many different aspects that make up a claim. A rough breakdown of Neils is as follows: (15% discount is applied afterwards)
Pain and suffering – £100,000
Interest – £4,500
Ongoing treatment costs – £25,000
Past loss of earnings – £90,000
Interest – £828
Future loss of earnings – £400,000
Pension – £25,000
Past care – £35,000
Miscellaneous expenses (including interest) – £50,000
Transport, aids and equipment and expenses (including interest) – £26,692
Future care – £308,057
The final figure was just over £905000. Following the settlement, Neil commented “If I could turn back time four years I would. I loved getting up and going out to work. Driving HGV vehicles is all I’ve ever done. The accident in itself was horrendous but life since has been far worse. The pain I suffer on a daily basis and lack of independence has been the biggest challenge and still is. Brian and his team have worked tirelessly to get the result achieved. Although I wish I could turn back time, Brian has helped to get a result that will help me to provide for my family in the future.”
Brian Barr was delighted with the high level of compensation he was able to secure for Neil. “This will go some way to making life a little easier for Neil and his wonderful family. The accident came as a terrible blow to Neil, but he is a brave man and he has managed to make the most of very difficult circumstances. I feel quite sure that he will continue to do so in the future with continuing excellent support from his wife Amanda. We have specialist knowledge and expertise in CRPS cases and we are happy to help as many CRPS sufferers as we can”.
Judge awards £290,000 to Brian Barr’s CRPS client.
Neil Bredbury injured his hand at work. He developed Complex Regional Pain Syndrome (CRPS). He brought a claim against his employers who accused him of grossly exaggerating for the purposes of financial gain. He took his case to trial represented by Brian Barr Solicitors and succeeded for some £290,000.
Mr Bredbury was a cash in transit security guard with Securitas UK Limited (now called Loomis). In August 2005 he injured his hand in a drum at work and developed CRPS.
On 5th May and 3rd June 2006, the Defendants’ surveillance operatives caught the Claimant on video vigorously polishing his car with his injured right hand and driving to Lytham when he had said that he did not drive. They accepted that he had been suffering with CRPS until May/June 2006, but thereafter alleged he had made a full or almost full recovery.
The Defendants claimed that there was a gross disparity between Mr Bredbury’s presentation on video and his stated abilities to various doctors. They asserted that he had deliberately exaggerated his injuries and offered him £12,700 to settle his claim in May 2008. Mr Bredbury’s union solicitors urged him to accept. He decided instead to approach Brian Barr Solicitors.
We immediately obtained copies of the videos which Mr Bredbury had still not seen.
He and his partner worked diligently on them and produced an excellent written critique pointing out that whilst it appeared that he had spent two and a half hours polishing his car with his injured right hand, he was, in fact, only shown for 13 minutes in total doing that polishing. Over an hour had been cut out or not filmed. The critique also highlighted many occasions on the May and June film, as well as two shorter films in December 2006, when Mr Bredbury was clearly using his left hand, whereas had he made a full recovery by May/June 2006, as the Defendants asserted, he would have been using his dominant right hand.
A full witness statement was prepared in which Mr Bredbury largely drew upon what had already been in his critique document. This was combined with his efforts to seek light work with his employers from November 2005 onwards despite his disabilities.
Brian Barr noted that Mr Bredbury’s GP and Pain Clinic records received from the union solicitors were out of date and incomplete. We applied for and obtained updated records. We noted that Mr Bredbury was receiving physiotherapy at the same time as he was receiving pain clinic treatment in the crucial period in mid 2006. We obtained all the physiotherapy records.
We instructed a London Barrister who considered that the Defendant’s existing offer of £12,700 should be accepted. We then instructed a Manchester Barrister who said the same. It was only when we approached a third Barrister that real progress was made.
The pain consultants for both sides had been very sceptical on seeing the videos and believed that Mr Bredbury was exaggerating.
However, once Mr Bredbury’s pain consultant saw the records that we had obtained and saw better witness statements, his position changed. He was much more supportive than he had been.
The case went to trial in November 2009. Mr Bredbury’s hard work on the videos really paid off. Although the pain consultants felt that they showed normal or near normal use of the right hand, the Judge totally disagreed. He saw clear signs of disability.
The Judge found in Mr Bredbury’s favour on virtually every point. He was awarded damages of some £360,000, but because there had been an agreement on liability on an 80/20 basis in favour of Mr Bredbury, his damages were reduced to £290,000. This “hopeless” case had been transformed from an ugly duckling into an attractive swan by the use of good old fashioned hard work and legal skills.
Ms BJB underwent various treatments for her injuries. Following the treatments she suffered dizziness, pain, headaches and nausea.Unfortunately, despite the treatments, Ms BJB was left with a wrist that was of little functional use. She had to wear a wrist splint during the day for the foreseeable future. She also suffered virtually continuous pain in her right hand.
Amongst other difficulties she experienced a reduced power of grip in her hand. This was particularly devastating for Ms BJB as prior to her accident she was a professional musician and a very gifted double bass player. She had studied at the Royal Academy of Music. Had she not succeeded as a soloist she would have obtained a position in a leading orchestra. However, as a result of her injuries she was unable to play the double bass. Her career as a professional musician had therefore come to an end.
The court accepted the Reflex Sympathetic Dystrophy had been caused by the accident and she was awarded £194,582.79 plus interest.
If you’re looking for more information about how to cover the cost of your CRPS compensation claim, then explore our funding options below.
Brian Barr Solicitors are a leading CRPS lawyer firm, particularly in cases where CRPS has been caused by an injury. We know how debilitating the condition can be and will assist with claims for Total Permanent Disability under Critical Illness Policies or Accident Protection Policies. Additionally, if you had an accident and your solicitor advised you to settle for too little, we may have a remedy.