Author: Betsylew R. Miale-Gix

Reflex Sympathetic Dystrophy Syndrome (RSDS/CRPS) is a chronic pain disorder involving the sympathetic nervous system. While the precipitating mechanism of the signs and symptoms characteristic of RSDS has not been defined, abnormalities of the sympathetic nervous system have been strongly implicated. More often than not, Complex Regional Pain Syndrome ( RSDS) develops after a traumatic injury. RSDS/CRPS can also be a complication of surgery, infection, casting or splinting and myocardial infarction (heart attack).

The Social Security Administration began the process of formulating policy guidelines for this condition two years ago at the request of the Reflex Sympathetic Dystrophy Association of America. There was and has been an ongoing problem of individuals with significant RSDS having their applications for disability benefits routinely delayed or denied. There are several critical points emphasized:

RSDS/CRPS is a chronic pain syndrome most often resulting from trauma to a single extremity;

RSDS/CRPS patients report burning, aching, searing pain that is initially localized at the site of the injury. The involved area usually has increased sensitivity to touch. The pain syndrome may appear to be out of proportion to the inciting traumatic injury;

Inappropriate or exaggerated neural signals are sent to the brain that may then misinterpret non-painful stimuli as painful;

Early recognition of the syndrome and prompt treatment, ideally within 3 months of the first symptoms, provides the greatest opportunity for effective recovery;

RSDS/CRPS often affects an individual's ability to perform sustained work activity;

Some investigators have found that the signs and symptoms of RSDS/CRPS can persist longer than 12 months and in many cases lasts for years.

The Social Security Administration's guidelines provide some insight into what signs to look for such as: Abnormal Movements; Dystrophic Nails; Abnormal Hair or Nail Growth, Autonomic changes including skin color, temperature, or trophic changes in the affected area.

It was also noted that many of these medical signs are not static. They undergo dynamic changes over time and several examinations may be required before the sign can be documented. Further, that Complex Regional Pain Syndrome (RSDS), documented by appropriate medical signs, is a medically determinable impairment that can last for 12 or more months and be the basis for a finding of disability.

This ground breaking Social Security Administration document has significant ramifications in the area of Washington State patient's access to health care as well as to insurance and personal injury law. When a provider comes across RSDS/CRPS like symptoms an immediate referral is recommended to a specialist to confirm the diagnosis and begin immediate intervention.

Where RSDS symptoms result from traumatic injury or from surgery (if necessitated by traumatic injury), it presents the patient with a host of insurance and legal rapids to navigate through. In this situation, legal consultation, and possible legal representation by experienced personal injury recovery attorneys is needed to protect the patient's access to health care and insurance health benefits. Acceptance by a governmental agency of the causal link between traumatic injury and RSDS/CRPS will assist doctors with diagnosing and treating the condition, and allow legal counsel to level the playing field when working with the insurance companies.

At Adler Giersch PS we understand the diverse needs and complex medical and legal issues associated with Complex Regional Pain Syndrome (RSDS) and stand ready to assist your patients with their medical-legal and insurance needs.