Complex regional pain syndrome: a chronic disabling condition

Complex regional pain syndrome

Complex regional pain syndrome (abbreviated as CRPS) is a condition that causes persistent and severe debilitating pain. CRPS typically affects the extremities such as arms, legs, feet, or hands, but can affect any part of the body. CRPS also often occurs after an event such as an injury or surgery; however, the pain is disproportionately high compared with the severity of the actual injury. The cause of CRPS is not straightforward and likely does not have a single cause. CRPS may be the result of general inflammation or changes in the central nervous system. The pain receptors in the affected part of the body may become responsive to a group of nervous system messengers called catecholamines. In most cases, CRPS is triggered by some type of trauma to the affected body part which causes damage to the autonomic nerve fibers. Symptoms of CRPS may be caused by damage to the small fibers which control circulation. This causes blood vessels in the affected area of the body to become wider and leak fluid into the surrounding tissue. This causes swelling and muscle weakness as the underlying muscles and deep tissue are unable to receive sufficient oxygen and nutrients. The symptoms of CRPS include burning pain, sensitivity to touch or cold, changes in nail and hair growth pattern, skin changes such as temperature or color change, swelling and stiffness in the joints, and a decreased ability to move the body part which is affected by CRPS. In addition, CRPS symptoms may be exacerbated by emotional stress. CRPS cannot be diagnosed by one specific test. Typically, a doctor who is well versed in sensory nerve patterns such as a neurologist will conduct a detailed examination. The doctor may order nerve conduction studies as well. Imaging studies such as MRIs or CT scans may reveal any underlying nerve damage. There is no standard treatment for CRPS, and the treatment rendered aims to relieve symptoms rather than cure the condition. Treatment options may include physical therapy and occupational therapy, psychotherapy to address stress-related triggers of CRPS symptoms, mirror therapy, and desensitization. Medications include ketamine, dextromethorphan, opioids, antidepressants, botox injections, some anti-seizure medications, and bisphosphonates. Other treatment options include nerve blocks, intrathecal drug pumps, spinal cord stimulation, and dorsal root ganglia stimulation.

If you are suffering from CRPS, you may be having difficulty with performing your activities of daily living and maintaining normal work activities. If this is the case for you, you may be entitled to Social Security Disability benefits. Social Security Disability benefits are available to those who have worked and paid taxes on their income and are unable to perform substantial work activity due to a condition that has lasted or is expected to last for at least twelve months or result in death. If you have cut back your work due to your condition but have not stopped working, your earnings must fall under the monthly threshold Social Security establishes to be “substantial gainful activity.” Note that Social Security looks at your GROSS earnings per month and not your take-home pay when establishing whether you fall under this threshold.

When Social Security evaluates your claim, it will first confirm that you are not engaging in substantial gainful activity after the date of your disability as indicated above. Selecting a date of disability, referred to by Social Security as the alleged onset date, can be somewhat confusing, especially if you have been suffering from CRPS for an extended period of time – many individuals choose to select the date that they stopped working. Note that the alleged onset date needs to be supported by medical records. Therefore, you will also need to select a date during which you received treatment.

Social Security will then evaluate whether your condition is considered to be a severe impairment. When completing your application, it is best to list all of the medical conditions for which you have received medical treatment. If the condition is chronic and severe enough to have an impact on your level of functioning, Social Security may include symptoms from this condition to limit areas of functioning you may have when determining your capacity to perform work-related activities.

After reviewing your severe impairments, Social Security will then assess your residual functional capacity. Your residual functional capacity is essentially a framework of your ability to perform both physical and mental activities. For example, relating to physical activities, Social Security will determine how many hours you can sit and stand out of an 8-hour workday, how much weight you can lift and carry, and how frequently you can perform activities such as climbing stairs or stoop. Social Security will also assess any mental limitations you may have. For example, individuals with mental health conditions may be limited in their ability to interact with the public or with coworkers and supervisors. Those with CRPS will likely have limitations in how long you can stand or how much weight you can carry due to your physical pain. Additionally, it is possible to have mental limitations due to side effects from pain medication or the ability to tolerate stressful environments, as CRPS symptoms may be triggered by stress. Once your residual functional capacity is determined, Social Security will then determine whether you can perform your past work in light of your limitations. If not, Social Security will then determine whether there are other jobs that you can perform with the limitations that you have in your residual functional capacity. If there are no other jobs, Social Security will find you to be disabled.

Trying to navigate the Social Security Disability process is very challenging. It is not recommended that you try to do so on your own. The Social Security Disability team at LaBovick Law Group is highly experienced in handling disability cases, from the application phase to the hearing phase. Give us a call at (561) 625-8400. We will provide a free case evaluation and assist you every step of the way so that you are in the best position for success with your disability claim.

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