Tag Archives: CRPS

CRPS : Systemic Injury?

This blog previously discussed the legal issues related to workers suffering from Complex Regional Pain Syndrome (CRPS).  Under Wisconsin law, there is a vast difference (in effect and value) for an injury to a worker’s “body as a whole” (spine, head) versus a limb injury.  CRPS can fall into either category–making it an extremely difficult issue in litigation.

A recent California case provided an interesting case study.  While this case involved the use of AMA guides-which Wisconsin does not use–the medical discussion is interesting.  Most notably, a section of the AMA guides indicated that “the pathology in CRPS is currently believed to occur in the central nervous system.”  A nervous system condition certainly looks like a systemic issue–a “body as a whole” condition.  

If CRPS is viewed in that light in Wisconsin, it would open to the door to loss of earning capacity claims involving a CRPS diagnosis.

Complex Regional Pain Syndrome: Legal difficulties in Wisconsin

Complex regional pain syndrome (formerly known as reflex sympathetic dystrophy) can be a catastrophic disability for an injured worker.  Complex regional pain syndrome (CRPS) is a pain condition that can affect specific body parts after an injury, with some nasty symptoms: burning/throbbing pain, swelling, severe sensitivity to touch or temperature, color changes, or strange hair growth or nail growth.

A classic example is a worker with a “simple” ankle injury that heals slowly with a later developing CRPS condition affecting the entire leg and potentially the back.  Many instances of CRPS occur from lack of appropriate or timely medical care for an injury.   What should have been a resolved ankle injury and medical fix can morph into a debilitating chronic condition–causing severe pain and continuing off-work status.

In Wisconsin, there is an arbitrary distinction between two basic categories of injuries: scheduled injuries (limbs, eyes, ears) and non-scheduled injuries (torso, head, systemic and mental). The distinction between the two categories is important because scheduled injuries are compensated very differently from non-scheduled injuries. The difference is especially important because for scheduled injuries no additional compensation is allowed for a resulting loss of earning capacity (LOEC). Only certain employees with permanent disability resulting from a non-scheduled injury may be entitled to additional permanent disability benefits in the form of compensation for a resulting loss of earning capacity.

When evaluating CRPS, the Wisconsin Labor and Industry Review Commission generally makes the scheduled vs. unscheduled injury distinction based on the location of pain and symptoms.  See Michael S. Murawski v. Contract Transport Services, WC Claim No. 2000-041229 (LIRC Nov. 26, 2003).  For example, if the evidence shows pain symptoms and disability in the back, the Commission has found an unscheduled component, with resulting loss of earning capacity award.  The following cases are helpful:

  •  Vanremmen v. Central Processing Corp. 2013 WL 660185, WC Claim No. 2006-022071 (LIRC Jan. 22, 2013) (Left foot injury with resulting CRPS diagnosis, abnormal gait, and need for spinal cord stimulator. Evidence supported pain symptoms and complaints in spine, and Commission found ascertainable portion of disability due to unscheduled back component and awarded permanent total disability benefits.);
  • Tomasovich v. County Transit Corp., 2003 WL 21634016, WC Claim No. 1995-055411 (LIRC June 6, 2003) (Commission awarded permanent total disability based on an arm injury and resulting complex regional pain syndrome.  Applicant credibly testified that pain radiated from arm into upper back, and treating physician credibly demonstrated that CRPS caused cervical spine nerves to become over sensitized and respond excessively to every day stimuli);
  • McNaughton v. Wal-Mart Associates Inc., 2012 WL 3288877, WC Claim No. 2005-014491 (LIRC July 23, 2012) (Foot trauma with alleged CRPS restricted to a scheduled injury as the Commission found no medical evidence of a disability involving the spine).

CRPS does not automatically equal an unscheduled injury (with resulting possibility for a loss of earning capacity).  The injured worker, physician, and attorney must document a disability, symptoms, or condition affecting an unscheduled component–like the neck or back.  If disability in an unscheduled body part is found, the worker can present a loss of earning capacity opinion.

How Can Complex Regional Pain Syndrome (CRPS) Be Treated? (Part 2)

Treatments can vary as symptoms change over time.

Today’s post comes from guest author Todd Bennett from Rehm, Bennett & Moore.

Today’s post is continued from last week, when we discussed the symptoms of Complex Regional Pain Syndrome (CRPS). Today we will discuss treatment options.

The job of your doctor is to identify and treat your symptoms before they become incurable. Common forms of treatment for CRPS are 

  • physical therapy
  • injections
  • sympathetic mediated injections
  • sympathetic blocks
  • nerve conduction studies
  • CT scans
  • vasomotor studies
  • Doppler studies
  • bone-density tests
  • medications for pain & anti-inflammation

No single form of treatment has been found 100% effective.  Continue reading

What Is Complex Regional Pain Syndrome (CRPS)? (Part 1)

Diagnosis of CRPS is made through process of elimination.

Today’s post comes from guest author Todd Bennett from Rehm, Bennett & Moore. Complex Regional Pain Syndrome (CRPS) diagnosis is particularly important in Wisconsin Workers’ Comp, because  scheduled injuries stemming from a limb (arm, hands, leg, foot) are valued significantly lower than unscheduled (back, torso, mental) injuries. A hand or foot injury that results in CRPS migrates from the limb to the spinal canal, and thus becomes a “body as a whole “injury. If the permanent restrictions from the CRPS preclude a return to work, then a Loss of Earning Capacity award is possible—which would not be possible for a limb injury itself.

Representing clients with chronic pain is both one of the hardest and most rewarding parts of my job.

The International Association for the Study of Pain sets forth four diagnostic criteria for Complex Regional Pain Syndrome (CRPS):

  1. an initiating event,
  2. continuous pain,
  3. edema, temperature, or color differences affecting a limb, and
  4. excluding all other causes.

These criteria are vague but, because diagnosis of CRPS is elusive, they are the established criteria for a physician identifying and treating chronic pain that cannot be attributed to any other cause.

When your doctor believes the pain you are experiencing is out of proportion to your examination findings and the severity of your injury, it creates a problem. However, this is quite common when suffering from complex regional pain syndrome. While those who suffer from CRPS are often frurstrated because the exact cause of the pain cannot be proven, the medical literature confirms that this disease, and the resulting pain, is real!

The 3 stages of complex regional pain syndrome, ie. chronic pain, are variable but the descriptions below show how the disease can progress: Continue reading