Complex Regional Pain Syndrome (CRPS), which used to be known as Reflex Sympathetic Dystrophy (RSD), is a chronic, painful condition where high levels of nerve impulses are sent to an affected site, usually after an injury has healed. The pain is so intense that individuals with CRPS are unable to concentrate on the tasks of their occupations.
Because CRPS is not a disease that can be measured easily with a blood test, CRPS disability claims are often challenged by long-term disability insurance companies. RSD is an older term used to describe one form of CRPS. RSD is also referred to as Type 1 CRPS.
Complex Regional Pain Syndrome (CRPS), or Reflex Sympathetic Dystrophy (RSD), is a painful and progressive disorder that affects skin, muscles, joints, nerves, and bones. Many RSD or CRPS cases start with a very minor injury – even a mild sprain can set off RSD/CRPS, and many cases start with no apparent injury at all. It can also occur after a heart attack.
Many experts believe that CRPS is a result of dysfunction in the central or peripheral nervous systems. There are theories that the syndrome is caused by pain receptors at the site of the injury that somehow become responsive to a group of nervous system messengers, catecholamines. The sympathetic nervous system is the part of the nervous system that controls blood flow movements that help regulate heart rate, blood pressure, and blood flow. When an injury occurs to the body, the sympathetic nervous system instructs the blood vessels to shrink to avoid too much blood loss from occurring at the site of the injury. When the system is working properly, as the injury heals, the blood vessels are instructed to return to their original state.
With CRPS, the sympathetic nervous system is not receiving correct signals and does not turn itself off.
Even when the injury seems to have healed, there continues to be intense pain and swelling or extreme temperatures at the site of the injury.
CRPS is generally diagnosed through observation of symptoms, which is always treated as a red flag for the disability insurance company. There are some diagnostic tests that can be done to objectively determine whether CRPS is present. MRI (Magnetic Resonance Imaging) may show tissue changes, including skin thinning and muscle atrophy. Tests of the sympathetic nervous system may be performed to compare one part of the body on one side to another. For instance, a test measuring blood flow or the amount of sweat on the right and left legs would demonstrate a healthy leg compared to a leg affected by CRPS. There are changes in the skin temperature, where skin on one leg or arm may feel much warmer or colder compared to the opposite leg or arm.
Skin color changes are also a symptom of CRPS, with skin that is pale, blotchy, purple or red. Some CRPS patients sweat to an excessive degree, with no apparent reason. Most people describe CRPS pain as aching, burning, cold, throbbing, and they see redness and swelling. Often, the skin around the site of the injury is warm to the touch. The physician may order a triple-phase bone scan to see if any bones are wearing away at the ends, or if there are any blood flow issues.
The Mayo Clinic describes CRPS as occurring in two different types, with different causes:
Type 1. Also known as Reflex Sympathetic Dystrophy (RSD), occurs after an illness or injury that didn’t directly damage the nerves in the affected limb. About 90% of people with CRPS have type 1.
Type 2. Once referred to as Causalgia, symptoms are similar to those of Type 1, but type 2 CRPS occurs after a distinct nerve injury.
There is no cure for CRPS, but there are treatments to relieve the pain associated with CRPS.
Sympathetic nerve blocks: These blocks, which are done in a variety of ways, can provide significant pain relief for some people. One kind of block involves placing an anesthetic next to the spine to directly block the sympathetic nerves.
Surgical sympathectomy: This controversial technique destroys the nerves involved in CRPS. Some experts believe it has a favorable outcome, while other experts believe it makes CRPS worse. The technique should be considered only for people whose pain is dramatically but temporarily relieved by selective sympathetic blocks.
Intrathecal drug pumps: These pumps used an implanted catheter to send pain-relieving drugs right into the spinal fluid.
Spinal cord stimulation: This technique, in which electrodes are placed next to the spinal cord, appears to help many patients with their pain.
If you are suffering from RSD/CRPS, and intend to file a claim for disability insurance benefits, it is strongly recommended that you work with an attorney or a consultant with experience before filing a claim under a disability insurance policy. It is likely that the claim will be heavily scrutinized and then delayed or denied from the start. The nature of the condition will cause potential challenges.
RSD/CRPS patients need to work with their primary care physician to document all of the symptoms of the disease. While pain may be subjective, most of the other symptoms are extremely evident to the eye – swelling and color changes of the affected area, limited movement in the limb, irreversible skin damage, muscle atrophy – and can be clearly documented in a medical file. It is also important that the treating physician note the limitations on activities created or impacted by RSD/CRPS. If you can no longer lift your right arm, you cannot possibly function as a dentist, an eye doctor, or in any profession that requires fine motor skills.
If you are about to file for a disability insurance claim because of RSD/CRPS, or if you have filed and are experiencing problems with getting benefits paid, you should speak with an experienced long-term disability insurance policy attorney who has successfully handled RSD/CRPS claims.
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