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Complex Regional Pain Syndrome (CRPS) is challenging. The March/April 2006 issue of The Guides Newsletter included a sidebar entitled “Rating Impairment for CRPS type 1.” 1 It states: Do NOT use the pain chapter to rate CRPS. The “three question test” on page 572 would disqualify use of this chapter for this diagnosis, as there is no “widely accepted … well-defined pathophysiologic basis.” This statement is simply a concise application of the following passages from the Guides to the Evaluation of Permanent Impairment, Fifth Edition , Chapter 18
Introduction The intent of this article is not to exhaustively review the evidence or controversy surrounding complex regional pain syndrome (CRPS), although some opinions on both sides are presented. The focus is on the diagnostic criteria for CRPS and how to determine if a patient with this syndrome has reached maximum medical improvement (MMI), and if so, how to rate permanent impairment. CRPS 1 , 2 is characterized by chronic spontaneous and/or evoked regional pain that usually begins in a distal extremity (upper more commonly than lower), and is
I. Introduction Complex regional pain syndrome (CRPS) is a controversial, ambiguous, and often unreliable concept which presents significant clinical and rating challenges. 1 — 5 This label is often encountered in performing impairment evaluations since the vast majority of such diagnoses occur in a workers compensation context. 6 , 7 This article focuses on the problems with this diagnosis and the differential diagnosis that must be considered. The challenges that a clinician faces when considering a diagnosis of CRPS have been extensively chronicled
Complex regional pain syndrome (CRPS) is a controversial, ambiguous, unreliable, and unvalidated concept. 1 At a recent American Academy of Orthopaedic Surgeons continuing education course, one lecturer listed it as one of the “social constructs” that cannot be comprehended based on health science and can only be understood as an invented concept which has no basis other than an agreement between people who have decided to behave as if it actually exists. 2 Similarly, the continuing education programming of the American Academy of Neurology has included a
correspond to other disturbances (motor, trophic, vasomotor, etc) of the involved nerve structure? Failure to address one or more of these questions regarding sensation is a common error in IR reports. Complex Regional Pain Syndrome One of the most challenging diagnoses to assess is complex regional pain syndrome, as discussed in Section 16.5, Complex Regional Pain Syndrome Impairment (6th ed, 538-542). The approach is identical to that used with the UE. It is critically important to confirm the diagnosis, including that it has been present for more than 1 year
Regional Pain Syndrome One of the most challenging diagnoses to assess is complex regional pain syndrome (CRPS), as discussed in Section 15.5, Complex Regional Pain Syndrome Impairment (6th ed, 450–454). It is critically important to confirm that the diagnosis has been confirmed, present for more than one year, verified by more than one physician, and a comprehensive differential diagnosis has ruled out other explanations. The rating must be based on objective findings. Physician Bias A recent review of physician biases in orthopedic surgery 12 discusses several
Physicians use a variety of methodologies within the AMA Guides, Sixth Edition, to rate nerve injuries, depending on the type of injury and location of the nerve. Traumatic injuries that cause impairment to the peripheral or brachial plexus nerves are rated using Section 15.4e, Peripheral Nerve and Brachial Plexus Impairment (6th ed, 429–432), for upper extremities and Section 16.4c, Peripheral Nerve Rating Process (6th ed, 533–538), for lower extremities. Verifiable nerve lesions that incite the symptoms of complex regional pain syndrome, type II
The Guides Fifth Edition methods for rating impairment due to causalgia, reflex sympathetic dystrophy (RSD), and complex regional pain syndromes (CRPS) differ from the approach found in previous editions of the Guides . The Fifth Edition methods for rating these conditions are found in four chapters: Chapter 13, The Central and Peripheral Nervous System; Chapter 16, The Upper Extremities; Chapter 17, The Lower Extremities; and Chapter 18, Pain. Table A (page 3) summarizes the relevant chapters, sections, tables, and examples and will serve to
have been expanded to clarify when the different evaluation methods should be used, a new table, Guide to the Appropriate Combination of Evaluation Methods (Table 17-2), has been added to indicate which methods are appropriate to use in combination; the evaluation of causalgia and complex regional pain syndrome now follows the same principles used to evaluate central nervous system lesions; additional case examples are provided; and a lower extremity worksheet is provided as a template to simplify making the assessment and recording the evaluation. (5th ed
injuries and diagnoses have been added, (4) physical examination has been simplified, (5) functional assessment is provided through focused history-taking including information about activities of daily living (ADLs) and a functional assessment tool, (6) criteria for diagnosis of complex regional pain syndrome (CRPS) have been updated for consistency with current standards and other chapters, and (7) an Upper Extremity Impairment Evaluation Record is provided as a template to simplify recording of the evaluation. Principles of Assessment The principles of
