Complex Regional Pain Syndrome

By Melanie Burden and Claire Roantree

January 12 2016 - Guidance for Employers - What you need to know

Complex Regional Pain Syndrome (CPRS) is condition which is a mystery to many simply due to the fact that is not easily identified, is often misunderstood and misdiagnosed, and is also not very well publicised. In fact, it is an extremely painful condition where sufferers experience persistent, severe debilitating pain which can have an enormous impact on their lives and those around them. This disease can strike at any age and affects both men and women, although it is much more common in women.

As CRPS can often rear its ugly head in the workplace, Melanie Burden and Claire Roantree, expert lawyers from Simpson Millar Solicitors take the opportunity to guide employers on the condition, signs to look out for, how accidents leading to this type of accident can occur in the workplace and tips for prevention. The aim is to help educate employers should any employees be suffering from this either as a result of an accident, which occurred in the workplace or non work-related but resulting in absence from work. CPRS is a debilitating condition which can lead to pro-longed absence from work and / or call on the employer to consider any alternative roles or adjusted hours / working practice to accommodate their needs under the Disability Discrimination Act.

What part of the body can it affect?

It usually starts in the hand / arm or foot / leg but it can spread throughout the body

What are the symptoms?

Symptoms can include:

• A burning intense stabbing pain / it can also be described as a cold pain
• Experiencing pain from the lightest of touches - the medical term for this is allodynia (an example is experiencing a painful reaction from something that you would not normally expect to cause pain, such as stroking the skin with a feather)
• An extreme pain reaction to painful stimulation
• Continued intense pain after injury where you normally would have expected to make a full recovery
• Abnormal swelling in the area affected (the medical term is oedema)
• Skin Colour Changes / a mottling appearance to the skin
• Excessive sweating in the affected area
• Abnormal nail and / or abnormal hair growth
• Abnormal skin temperature in the affected area (where one side of the body differs by more than 1% to the other)
• Joint tenderness / stiffness
• Restricted or painful movement
• Cracked / grooved / brittle nails
• Tremors and muscle spasms (the medical term is dystonia)
• Difficulty sleeping
• Softening or thinning of the bones in the affected area

How can someone get CRPS?

Most cases of CRPS are usually triggered after an injury:

• From a musculo-skeletal injury or injury to the nerve
• The symptoms can come on from an injury as minor as a cut to the finger
• It can also come on after surgery (which is why it commonly comes on after surgery to repair fractures / damaged nerves after injuries to hands / arms / feet)
• It can also come on after immobilisation

How can it occur in the workplace?

The most common types of injuries we come across that can lead to CRPS and other painful conditions are:-

• Cuts from knives / lacerations in the catering industry / meat production / abattoirs
• Injuries where hands or feet become crushed or trapped on machinery /equipment
• Injuries where hands / fingers are crushed by closing doors / doors being obstructed
• Injuries where fingers become trapped in machinery / equipment resulting in finger amputation
• Injuries involving power tool either, causing electrocution or lacerations to fingers / the hand which sever tendons / cause nerve damage
• Any other type of laceration injury caused by handling objects with sharp / rough edges / glass
• Any injuries resulting in fractures to the fingers / hands / wrist / feet which require surgery to repair ( where nerves may be affected ) or a long period of immobilisation in a cast

How can any risk be avoided?

Prevention is the best policy by ensuring you are rigorous in the use and enforcement of Health and Safety in the workplace. Many are common sense and ought to be included already as part of the employer's responsibility under the Workplace Regulations, Work Equipment Regulations , Work at Height Regulations and Personal Protective Equipment Regulations.

• Ensure all risk assessment are regularly reviewed and updated
• Factor in the risk of serious injuries to the hands / feet / crush injuries if the task includes the use of power tools / cutting / use of sharp objects and anything that could give rise for a crush injury. Look what you can do to avoid that risk or reduce to the lowest possible level.
• Ensure the risk assessments are reviewed and up to date for the use of power tools. Ensure the equipment is regularly maintained and inspected and that this is documented.
• Where the equipment being used has a guard and stop controls, ensure the guard is in place and correctly fitted and that the stop controls are easily accessible.
• Ensure all employees are trained and supervised in the correct use of the equipment
• Risk assesses the workspace area / conditions to ensure that the power tool to be used is at a safe level, safe height and in sufficient space to enable the employee to operate it safely.
• Re-inforce the risk assessments / safety measures as part of the tool box talks
• Where protective equipment is available to use, such as safety boots, ensure the employee is provided with them and that they are wearing the equipment
• Check that the employee is competent to use the power tools in question and is not under the influence of any alcohol or recreational or prescription drugs that could affect their ability to operate the machinery safely

How could it affect you if an employee is injured and develops CRPS?

It is a serious pain condition and this type of injury can result in awards of damages into six figure sums due to the disabling effect it can have on an injured person and associated losses.

If your employee is injured and diagnosed with CRPS, consider the benefits of accessing early rehabilitation and treatment

In many cases a multi-disciplinary approach to treatment is required and it is said that the earlier the person commences treatment and rehabilitation, the better the outcome.

We have acted for clients where the Defendant Insurers and the Employer have worked collaboratively with the Claimant to access them early care and treatment, input from a vocational expert and occupational therapist which has meant that the Claimant has been able with advice and assistance to return to work.

Remember if an injured client does return to work, you need to re-risk assess them and their physical capabilities In the case of people suffering from CRPS and other pain conditions, they can often be taking strong opiate pain medications which can make them drowsy and this may affect their ability to drive or operate machinery. This needs to be fully risk - assessed.

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