Complex Regional Pain Syndrome: Impairment Assessment

2021 ◽  
Vol 26 (3) ◽  
pp. 8-13
Author(s):  
Steven D. Feinberg ◽  
Charles N. Brooks ◽  
Christopher R. Brigham
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Diagnostic Criteria ◽  
Pain Syndrome ◽  
Sixth Edition ◽  
Impairment Ratings ◽  
Rule Out

Abstract Complex regional pain syndrome (CRPS) is characterized by chronic spontaneous and/or evoked regional pain disproportionate in severity, distribution, and/or duration to that typically experienced after a similar injury or illness. The pain may also begin without a known precipitant. While various authors have questioned the validity of the diagnosis, physicians will be asked to perform impairment ratings on patients diagnosed with CRPS. Hence, it is important to understand the issues associated with this syndrome; the diagnostic criteria for it, including the need to rule out other diagnoses that may explain the patient's presentation; and how to rate CRPS. The AMA Guides to the Evaluation of Permanent Impairment, Fifth Edition, provides approaches to assessing CRPS impairment that are refined in the Sixth Edition.

A Historical Review of Complex Regional Pain Syndrome in the “Guides Library”

2009 ◽  
Vol 14 (6) ◽  
pp. 1-9
Author(s):  
Robert J. Barth
Keyword(s):  
Differential Diagnosis ◽  
Complex Regional Pain Syndrome ◽  
Reflex Sympathetic Dystrophy ◽  
International Association ◽  
Historical Review ◽  
Pain Syndrome ◽  
Sixth Edition

Abstract Complex regional pain syndrome (CRPS) is a controversial, ambiguous, unreliable, and unvalidated concept that, for these very reasons, has been justifiably ignored in the “AMA Guides Library” that includes the AMAGuides to the Evaluation of Permanent Impairment (AMA Guides), the AMA Guides Newsletter, and other publications in this suite. But because of the surge of CRPS-related medicolegal claims and the mission of the AMA Guides to assist those who adjudicate such claims, a discussion of CRPS is warranted, especially because of what some believe to be confusing recommendations regarding causation. In 1994, the International Association for the Study of Pain (IASP) introduced a newly invented concept, CRPS, to replace the concepts of reflex sympathetic dystrophy (replaced by CRPS I) and causalgia (replaced by CRPS II). An article in the November/December 1997 issue of The Guides Newsletter introduced CRPS and presciently recommended that evaluators avoid the IASP protocol in favor of extensive differential diagnosis based on objective findings. A series of articles in The Guides Newsletter in 2006 extensively discussed the shortcomings of CRPS. The AMA Guides, Sixth Edition, notes that the inherent lack of injury-relatedness for the nonvalidated concept of CRPS creates a dilemma for impairment evaluators. Focusing on impairment evaluation and not on injury-relatedness would greatly simplify use of the AMA Guides.

Peripheral Nerve and Brachial Plexus Impairment, AMA Guides, Sixth Edition

2017 ◽  
Vol 22 (2) ◽  
pp. 3-5
Author(s):  
James B. Talmage ◽  
Jay Blaisdell
Keyword(s):  
Peripheral Nerve ◽  
Brachial Plexus ◽  
Complex Regional Pain Syndrome ◽  
Lower Extremities ◽  
Pain Syndrome ◽  
Upper Extremities ◽  
Motor Deficits ◽  
Type I ◽  
Sixth Edition ◽  
Nerve Entrapments

Abstract Physicians use a variety of methodologies within the AMA Guides to the Evaluation of Permanent Impairment (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, for upper extremities and Section 16.4c, Peripheral Nerve Rating Process, for lower extremities. Verifiable nerve lesions that incite the symptoms of complex regional pain syndrome, type II (similar to the former concept of causalgia), also are rated in these sections. Nerve entrapments, which are not isolated traumatic events, are rated using the methodology in Section 15.4f, Entrapment Neuropathy. Type I complex regional pain syndrome is rated using Section 15.5, Complex Regional Pain Syndrome for upper extremities or Section 16.5, Complex Regional Pain Syndrome for lower extremities. The method for grading the sensory and motor deficits is analogous to the method described in previous editions of AMA Guides. Rating the permanent impairment of the peripheral nerves or brachial plexus is similar to the methodology used in the diagnosis-based impairment scheme with the exceptions that the physical examination grade modifier is never used to adjust the default rating and the names of individual nerves or plexus trunks, as opposed to the names of diagnoses, appear in the far left column of the rating grids.

Errata

2008 ◽  
Vol 13 (2) ◽  
pp. 5-5
Keyword(s):  
Psychotic Disorders ◽  
Pain Syndrome ◽  
Vestibular Disorders ◽  
Loss Of Function ◽  
Sixth Edition ◽  
Neurologic Disorders ◽  
Upper And Lower Extremities ◽  
Impairment Ratings ◽  
Extensive List ◽  
Mental And Behavioral Disorders

Abstract Although most chapters in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, instruct evaluators to perform impairment ratings by first assigning a diagnosis-based class and then assigning a grade within that class, Chapter 13, The Central and Peripheral Nervous System, continues to use a methodology similar to that of the fifth edition. The latter was criticized for duplicating materials that were presented in other chapters and for producing different ratings, so the revision of Chapter 13 attempts to maintain consistency between this chapter and those that address mental and behavioral disorders, loss of function in upper and lower extremities, loss of bowel control, and bladder and sexual function. A table titled Summary of Chapters Used to Rate Various Neurologic Disorders directs physicians to the relevant chapters (ie, instead of Chapter 13) to consult in rating neurologic disorders; the extensive list of conditions that should be addressed in other chapters includes but is not limited to radiculopathy, plexus injuries and other plexopathies, focal neuropathy, complex regional pain syndrome, visual and vestibular disorders, and a range of primary mood, anxiety, and psychotic disorders. The article comments in detail on sections of this chapter, identifies changes in the sixth edition, and provide guidance regarding use of the new edition, resulting in less duplication and greater consistency.

scholarly journals Proposed New Diagnostic Criteria for Complex Regional Pain Syndrome

Pain Medicine ◽  
2007 ◽  
Vol 8 (4) ◽  
pp. 326-331 ◽  
Author(s):  
R. Norman Harden ◽  
Stephen Bruehl ◽  
Michael Stanton-Hicks ◽  
Peter R. Wilson
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Diagnostic Criteria ◽  
Pain Syndrome

Complex regional pain syndrome: are the IASP diagnostic criteria valid and sufficiently comprehensive?

Pain ◽  
1999 ◽  
Vol 83 (2) ◽  
pp. 211-219 ◽  
Author(s):  
Norman R. Harden ◽  
Stephen Bruehl ◽  
Bradley S. Galer ◽  
Samuel Saltz ◽  
Martin Bertram ◽  
...  
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Diagnostic Criteria ◽  
Pain Syndrome

scholarly journals Validation of proposed diagnostic criteria (the “Budapest Criteria”) for Complex Regional Pain Syndrome

Pain ◽  
2010 ◽  
Vol 150 (2) ◽  
pp. 268-274 ◽  
Author(s):  
Norman R. Harden ◽  
Stephen Bruehl ◽  
Roberto S.G.M. Perez ◽  
Frank Birklein ◽  
Johan Marinus ◽  
...  
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Diagnostic Criteria ◽  
Pain Syndrome ◽  
Budapest Criteria

Special Feature: Complex Regional Pain Syndrome (CRPS): Unratable Through the Pain Chapter

2006 ◽  
Vol 11 (4) ◽  
pp. 4-8
Author(s):  
Robert J. Barth
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Diagnostic Criteria ◽  
Behavioral Disorders ◽  
Pain Syndrome ◽  
Diagnostic Systems ◽  
Professional Literature ◽  
Mental And Behavioral Disorders

Abstract A sidebar titled “Rating Impairment for [complex regional pain syndrome] CRPS Type 1” in the March/April issue of The Guides Newsletter states: “Do NOT use the pain chapter to rate CRPS” because there is no well-defined pathophysiologic basis. That conclusion is contradicted by the pain chapter, which lists CRPS among conditions considered ratable, but accompanying text provides no explanation how this determination was made. This article attempts to resolve the conflict between the sidebar in The Guides Newsletter and the pain chapter. The lack of a well-defined pathophysiologic basis for CRPS is the reason for the position stated in the sidebar, and a review of the relevant professional literature confirms this reasoning. Further, the concept of CRPS itself is ambiguous and was intentionally designed to be “general” and “descriptive” and historically has been diagnosed using nonstandardized, idiosyncratic, or incompatible diagnostic systems. The AMA Guides to the Evaluation of Permanent Impairment is self-contradictory regarding diagnostic criteria and terminology (eg, is CRPS-1 synonymous with RSD, causalgia, or neither?). CRPS lacks any well-defined pathophysiology, is highly ambiguous and controversial, involves characteristics that compromise the credibility of any examinee making such a presentation, and is a good example of a condition that should be evaluated using the mental and behavioral disorders chapter.

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