What are central sensitivity syndromes (“CSS”)?
CSS are illnesses that are debilitating and very difficult to diagnose for the sole fact that there are no tests that may be administered to conclude a definitive diagnosis. Examples of central sensitivity syndromes are myalgic encephalomyelitis, chronic fatigue syndrome and fibromyalgia to name a few.
As per the Centers for Disease Control and Prevention site, these conditions are explained further:
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a disabling and complex illness.
People with ME/CFS are often not able to do their usual activities. At times, ME/CFS may confine them to bed. People with ME/CFS have overwhelming fatigue that is not improved by rest. ME/CFS may get worse after any activity, whether it’s physical or mental. This symptom is known as post-exertional malaise (PEM). Other symptoms can include problems with sleep, thinking and concentrating, pain, and dizziness. People with ME/CFS may not look ill. However,
- People with ME/CFS are not able to function the same way they did before they became ill.
- ME/CFS changes people’s ability to do daily tasks, like taking a shower or preparing a meal.
- ME/CFS often makes it hard to keep a job, go to school, and take part in family and social life.
- ME/CFS can last for years and sometimes leads to serious disability.
- At least one in four ME/CFS patients is bed- or house-bound for long periods during their illness.
Anyone can get ME/CFS. While most common in people between 40 and 60 years old, the illness affects children, adolescents, and adults of all ages. Among adults, women are affected more often than men. …Many people with ME/CFS have not been diagnosed, especially among minorities.
HealthLINK BC also provides further information on causes, symptoms, diagnosis and treatment:
What causes ME/CFS?
Doctors don’t know what causes ME/CFS. It seems to follow after a flu-like illness like Epstein-Barr Virus (EBV). High stress may also lead to ME/CFS for some people. And changes in a person’s immune system may also play a role. It’s likely that a number of factors or triggers come together to cause ME/CFS.
What are the symptoms?
Symptoms can vary with ME/CFS. If you have ME/CFS:
- You feel exhausted all or much of the time. And it doesn’t get better with rest.
- Your symptoms may flare up after a mental or physical activity that used to be no problem for you. Often there is a delay before it starts. And it can take days, weeks, or more to feel better.
- You have problems sleeping. Or you may wake up feeling tired or not rested.
- It may be harder for you to think clearly, to concentrate, and to remember things.
- You may feel dizzy, weak, or in more pain when you have been standing or sitting upright for a long time.
- You may also have headaches, muscle and joint pain, a sore throat, and tender glands in your neck or armpits.
Depression is common with ME/CFS, and it can make your other symptoms worse.
How is ME/CFS diagnosed?
To be diagnosed with ME/CFS, you must have all of these symptoms:footnote1
- Major decrease in your ability to do the things you did before you got sick—including work, school, social, or personal activities—that has continued for more than 6 months.
- Worsening of symptoms after being mentally or physically active (post-exertional malaise).
- Sleep problems, including not feeling rested after sleeping (unrefreshed sleep).
- Extreme fatigue that is:
- New or has not been a lifelong problem.
- Not caused by being active for a long period of time.
- Not much better after resting.
You must also have one or more of these symptoms:
- Problems with concentration, short-term memory, or thinking of the right word (cognitive impairment).
- Feeling dizzy or faint while standing or sitting upright that improves while lying down (orthostatic intolerance).
Doctors may also look for other causes of your symptoms. They may also do additional tests to confirm your diagnosis.
How is it treated?
There is no treatment for ME/CFS itself, but many of its symptoms can be treated. A good relationship with your doctor is important. That’s because the two of you will need to work together to find a combination of medicines and lifestyle adjustments that will help you get better. Some trial and error may be needed, because no single combination of treatments works for everyone.
Home treatment is very important. You may need to change your daily schedule, learn better sleep habits, and use regular gentle movement or exercise to manage fatigue. Even at times when you have more energy, keep a low-key pace throughout each day. Rest often.
When you have ME/CFS, you may not be able to do the things you would like to do. This may lead to feelings of frustration and anxiety. It can also lead to depression. Depression is not the same thing as ME/CFS. But it can make your ME/CFS symptoms worse.
Learning to cope with your symptoms and talking to others who have ME/CFS can help. So can working with a counsellor.
Central Sensitivity Syndromes – Legal Claims
Diagnosing CSS creates multiple challenges in a legal claim due to the lack of objective evidence.
We are going to refer to multiple published decisions that will provide further information from a medical perspective and the compelling factors that were raised in these cases that allowed the Courts to find that these syndromes were in fact caused by the trauma sustained in these motor vehicle accidents, and that compensation was warranted under multiple categories of loss.
This decision involves a 64 year old Plaintiff who was very active in her life when she was involved in a motor vehicle collision on Nov. 8, 2011 and an onset of pain and symptoms changed her life. She was diagnosed with chronic pain in her neck region, cervicogenic headaches, tinnitus and vertigo, poor sleep, and altered mood due to pain and restricted function. What is noted and most common in these cases is that the credibility of the Plaintiff is helpful when dealing with conditions where a lack of objective evidence exists. In this case the Court states:
I had the opportunity to observe Ms. Gabert during her two days of testimony. I was impressed with Ms. Gabert and found her to be a sincere and honest witness who endeavoured to provide the Court with an accurate and detailed account of her situation as it was before and as it is after the accident. I did not find frailties in her memory, or that she was influenced by an interest to change her recollection of the events in her favour.
It is also noted that, in this specific case, the experts agreed that the Plaintiff was injured as indicated and her function was seriously impaired:
“the medical evidence establishes a compelling portrait of an injured person who has and continues to deal with the adverse effects of her pain. The evidence is based on multiple assessments of Ms. Gabert and review of her clinical records. Her recollection and testimony as to her post-accident condition is clear and corroborated by the preponderance of the expert testimony.”
The specialist in this case, an internal medicine physician, educates us on central sensitivity syndromes:
“The challenges associated with diagnosing and treating those chronic fatigue syndrome and fibromyalgia: The challenge is due to the fact that these syndromes which are just two of many central sensitivity syndromes, “don’t have abnormalities that can be seen with a microscope or picked up by usual medical tests”. Hence, the diagnosis is often met with skepticism from others in the medical field.
The case further goes on to discuss fibromyalgia, another known central sensitivity syndrome:
“the cause of fibromyalgia is unknown but the medical literature indicated it can be triggered by trauma, including motor vehicle accidents. At page 9 of his report, he elaborates on central sensitivity syndromes:
Central sensitivity syndromes (CSS) belong to a family of syndromes that don’t have abnormalities that can be seen with a microscope or picked up by usual medical tests. They share the common mechanism of “central sensitization.” Central means the problem is at the level of the brain and spinal cord. The neurons (brain and spinal cord cells) are “hyper-excitable” or sensitized because of changes in the way the cells communicate chemically and through other mechanisms. The sensitized cells amplify, or make stronger, messages that we get from our sense (for example touch can feel like pain, normal lighting or sound can be experienced as uncomfortable). But the cells are not just sensitised; they often send “wrong’ information as well, and they can also trigger abnormal responses to the environment. For instance, the cells can send information causing the heart to race, feelings of dizziness, or interfere with a body temperature regulation. New sensitivities to food, chemicals, and medications can also occur.”
It is further noted:
Too often, the CSS have gone undiagnosed. We usually see a precipitant, or trigger, causing the onset of symptoms. The precipitant is some form of stressor. This includes:
- infections (for example after a flu);
- physical trauma (for example after a car accident); or
- psychological stress or trauma (for example “burn out” or even a single traumatic event).
It is important to understand the triggers that may cause centralized sensitivity syndrome as it may require further investigation by an internal medicine specialist, including physiatry, to assist with the diagnosis.
What is unfortunate is that there is no cure and typically the prognosis is not very good.
The Plaintiff was 31 years old at the time he was involved in a motor vehicle accident on Sept. 4, 2014 with two subsequent accidents. The Plaintiff suffered injuries to his knees, back, left ankle, both arms, neck and wrist, causing numbness, loss of sleep, depression, various bruises and lacerations, headaches, nausea and dizziness, including central sensitivity syndrome. His significant physical and psychological injuries, left him permanently disabled from working full-time. His non-pecuniary award was $200,000, with a total award of $1,384,000.
The physician in this case states that
“central sensitivity syndrome (“CSS”) refers to a group of medically indistinct or nonspecific disorders for which no organic cause can be identified. These include fibromyalgia, chronic fatigue syndrome, and irritable bowel syndrome.”
We do tend to see high awards when a Plaintiff is able to prove on a balance of probabilities that one of the resulting injuries caused by a motor vehicle accident results in CSS. Here are further decisions in which fibromyalgia or chronic fatigue syndrome has been identified, with a brief synopsis and the amount awarded for non-pecuniary damages:
Flomo v. Hanna, 2019 BCSC 2024: The 29-year-old plaintiff sustained injuries to her neck, upper back, lower back, shoulders and hips, due to a motor vehicle accident. She was diagnosed as suffering from fibromyalgia. All experts agreed that her injuries were chronic and the prognosis for her pain was permanent, leaving her with a lifetime of pain and suffering. In addition, she was found to have suffered from a major depressive disorder as a result of the accident. The court awarded $175,000.
Gabert v. Krist, 2018 BCSC 2109: The 71-year-old plaintiff suffered from “crushing skull pain”, headaches, tinnitus, arm pain, numbness of her feet and chronic fatigue syndrome as a result of a motor vehicle accident. Her conditions were “chronic, persistent and debilitating” many years after the accident, and her prognosis was poor. The court awarded $160,000.
Bruno v. Diamzon, 2014 BCSC 1270: The plaintiff was a 49-year-old claims manager who was injured as a result of a motor vehicle accident. The plaintiff suffered mechanical neck and back pain, fibromyalgia or a fibromyalgia-like condition, chronic pain disorder associated with sleep disorder and psychological factors, anxiety and depression, a major depressive disorder, post-traumatic stress disorder, and panic disorder with agoraphobia. The plaintiff continued to work for a number of years after the accident, but eventually took time off work to address his issues. His employment was subsequently terminated. All the injuries were found to be caused by the defendants’ wrongful conduct. The physical, psychological and emotional consequences of the accident negatively affected all aspects of the plaintiff’s life. He was in constant pain. The functionality of his back was impaired. His sleep was impaired and he suffered from chronic fatigue. He required medication and therapy to deal with his anxiety, panic attacks, depression and agoraphobia. Ordinary activities of daily living became a struggle. The court found that his condition, with appropriate treatment and medication, was not likely to deteriorate further, but his prognosis for substantial improvement was poor. The court awarded $120,000.
Contact Priscilla Cicek, Vice-President of Business Development, Legal Author and Analyst at Synoptic Medical Assessments for assistance in lining up your experts / IMEs in legal claims.
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