Decoding Complex Regional Pain Syndrome

In this episode, Dr. Fernando Branco, MEC AVP of Claims and Chief Medical Officer, tackles the multifaceted world of Complex Regional Pain Syndrome (CRPS) by drawing on decades of specialized experience in physical medicine, rehabilitation, pain management, and addiction medicine.

Dr. Branco provides valuable insights about:

•  How this complex diagnosis can create significant physical and emotional stress for patients.
• Why a proper CRPS diagnosis requires careful assessment of specific symptoms across three key categories: sensory system, vasomotor activity (blood flow) and sudomotor function (sweat glands). 
•  Diagnostic criteria to help distinguish true CRPS from other pain conditions.
• The pendulum swing from underdiagnosis to overdiagnosis and the importance of experienced medical assessment when evaluating potential CRPS cases. 

For claims professionals handling a claim with a CRPS diagnosis, this episode provides essential context that could change your approach to these challenging cases.

Chapters

• 0:00 Introduction to Expert Insights Series
• 0:37 Dr. Branco's Background and Expertise
• 1:25 History and Naming of CRPS
• 3:28 Diagnostic Criteria and Symptoms
• 5:12 Historical Context and Misdiagnosis
• 6:15 Closing Thoughts and Resources

Transcript

Sara Hance: 0:02

Hello, this is MEC Connect Expert Insights, a companion series to our main MEC Connect podcast for Midwest Employers' Casualty. I'm Sara Hance and in these Expert Insights episodes, you'll hear from a subject matter expert, as they share practical tips and strategies on a variety of topics related to workers' comp and claims management. Today, Dr. Fernando Bronco, AVP of Claims and Chief Medical Officer, will discuss Complex Regional Pain Syndrome, or CRPS. Now let's hear from Fernando.

Fernando Branco: 0:37

Hello, this is Fernando Branco. Thank you, sarah, for introducing me. I'm a physician. I'm specialized in physical medicine and rehabilitation. I'm a physician, I'm specialized in physical medicine and rehabilitation. I'm also board certified in pain and addiction and I have worked with this very difficult diagnosis for decades before joining Midwest. And today we're going to just have a very quick overview of this topic complex regional pain syndrome, crps. This is a diagnosis that, when is given to a patient, can create a lot of stress physical and emotional and also stress to whoever is handling a claim with this diagnosis. That is attached.

Fernando Branco: 1:25

If you are aware or not, but I'll give you a little bit of a history here Some of you are old enough, like me, that this diagnosis was actually called RSD. That's called reflex sympathetic dystrophy and in my view it's a slightly better description of this condition, because reflex sympathetic dystrophy it really talks about the sympathetic system that actually is on a short circuit with this condition and what it does is exacerbate all the organs and nerves that are controlled by the sympathetic system and they become irritated. You can call it this way. That's why I like reflex sympathetic dystrophy and, in my view, not such a great change, but it's water under the bridge at this point. In 1994, the International Association for the Study of Pain, iasp, decided that we needed to change this name reflex sympathetic dystrophy to CRPS type 1 and CRPS type 2, complex regional pain syndrome type 1, complex regional pain syndrome type 2. Type 1 will be the old reflex sympathetic dystrophy and type 2 will be what they will call causalgia. That will be this syndrome but associated with a specific nerve. It's not a very common finding. The vast majority of chronic regional pain syndromes will be type 1 or reflex sympathetic dystrophy. But you know, some of the academics felt that we needed to make this differentiation. That made a lot of sense for physicians and other medical care professionals, but I think it just created a little bit of confusion when everybody was somewhat used to the RSD. Still today people still call it that way.

Fernando Branco: 3:16

This is a very complex diagnosis that we need to have quite a bit of experience to really do a very good diagnosis quite a bit of experience. To really do a very good diagnosis you need to have at least one symptom in three areas of the following categories. One will be the sensory system. You're going to have hypersesia or allodynia. That basically is pain that is more than what it should be for the condition underlying and or something like you can barely touch or not even touch this patient and the pain that's already happening just getting close to the limb of this individual. There is also the vasomotor. There will be temperature changes. That's a way to make the diagnosis of this condition. Skin colors that's a very important thing. That will be somewhat pale, sometimes redness, and that will be part of this. Vasomotor changes, pseudomotor changes in edema, that means there will be swelling and in the late stages will be actually atrophy of the limb. There will be sweating changes. That's what pseudomotor means. Pseudo is sweat in Latin, and there will also be issues with the production of sweat and this is also a way to make the diagnosis. This can be done in the office by the doctor.

Fernando Branco: 4:35

One important piece that will be the fourth category you have to have changes in at least three of this. It's a motor traffic issue. There is problems with range of motion, problems with weakness, tremor, dystonia, that is, contracted muscles. That does not respond to pretty much any treatment, and traffic changes. These are very important. In general, they don't show up in the beginnings of the condition like it would be hair changes, nail changes, skin changes. If you go on the internet and Google this, what you're going to find is late stages and you're going to have all these factors extremely exacerbated in end stage.

Fernando Branco: 5:12

Unfortunately, most of the time this used to be underdiagnosed in the 80s I'm old enough I did medical school. In the early 80s Almost nobody got diagnosed with CRPS because there was a lot of ignorance of the diagnosis. One of the first specialties that really emphasized in this was physical medicine, rehab in neurologists, and eventually this became widely known by all specialties and they start diagnosing even when it isn't. If there is a problem that they can't resolve, they just label the patient CRPS. That is the type of condition that we definitely wanted to make sure that there's a very good examination.

Fernando Branco: 5:50

The diagnosis is complex besides the physical examination. I won't be able in this few minutes here to give you all the details, but I would recommend you to access one of our webinars that I have presented on complex regional pain syndrome that I go into details of that. Finalizing, I would say that, if anything that you can take out of this, this is a complex diagnosis. If it's truly complex regional pain syndrome, it will be a problematic diagnosis to treat. However, there is always treatment, the earlier the better, and the vast majority are not CRPS syndrome. That's my take in just a few minutes. As I said, if you need further information, we do have resources. Thank you and have a good day.

Sara Hance: 6:39

Thank you for tuning in to MEC Connect Expert Insights. I'm Sara Hance from Midwest Employers Casualty. We hope you found Dr. Bronco's insights on complex regional pain syndrome valuable. Stay tuned for more from MEC Connect and more expert insights. Thank you.