Symptoms, Criteria and Treatment of Complex Regional Pain Syndrome (“CRPS”)

A decision in McCaffery v Arguello, 2017 BCSC 1460 (CanLII) awards a Plaintiff $200,000 for injuries sustained in a road rage incident in which the Defendant was criminally charged with assault with a weapon and assault causing serious bodily harm. That charge provided a conclusion of 100% liability in which judgment was rendered against the Defendant with quantum to be assessed.

This post is going to focus on the medical findings concerning Complex Regional Pain Syndrome (“CRPS”) and I will quote from this decision the factual findings as it relates to (“CRPS”).

The medical evidence in this case was undisputed. There was no evidence called by the defence, in which the Defendant represented himself.

The diagnosis made by the medical expert, Dr. Negraaeff, was that the injuries suffered by the Plaintiff to his left hand was CRPS, including headaches. There were no pre-existing conditions that were a factor in this case.

As quoted from this decision, very helpful information that provides further awareness on CRPS:

Dr. Negraeff explained that CRPS is a form of chronic pain that usually develops in a limb after an injury to it.

Two Types of CRPS

There are two types of CRPS depending on whether a distinct nerve injury is confirmed.

  1. In the first type, there is no confirmed nerve injury; and
  2. In the second, such a nerve injury is confirmed.

The hallmarks of CRPS are pain which is out of proportion to the injury.

Symptoms

….and a combination of symptoms that can include: 

  1. Swelling;
  2. Skin colour; and
  3. Temperature changes,
  4. Sweating;
  5. Hair and nail growth changes; and
  6. Disturbances to the movement or coordination of the limb.

International Criteria For the Diagnosis of CRPS

[39]        International criteria have been established for the diagnosis of CRPS. Dr. Negraeff wrote that they include the following:

  1. Continuing pain which is disproportionate to any inciting event.
  2. The patient must report at least one symptom in three of the following categories: sensory, vasomotor, sudomotor/edema or motor/trophic.
  3. he patient must display at least one sign at the time of evaluation in two or more of the following categories: sensory, vasomotor, sudomotor/edema or motor/trophic.
  4. There are no other diagnoses that better explain the signs and symptoms.

[40]        Dr. Negraeff further explained that, in general, CRPS thought to be an exaggerated response by the nervous, immune, and vascular systems to injury. There may be actual damage to the nervous system or malfunctions in the system. There may also be genetic contributions to the risk of having CRPS, but these have not been fully worked out. Symptoms can range in severity from mild and self-limiting to severe and prolonged. Injuries are found in 90 percent of cases leading to CRPS, and those injuries vary from being quite mild to more serious.

Treatment – Multi-Disciplinary

[41]        Dr. Negraeff explained that a diagnosis of CRPS is a default diagnosis which is made after other causes of the signs and symptoms have been ruled out. Early multi-disciplinary treatment is necessary to preserve function and usually includes:

  1. Physical and occupational rehabilitation;
  2. pain relief medication,
  3. Procedures such as nerve blocks;
  4. Spinal cord stimulation, or
  5. Intravenous infusions such as ketamine or lidocaine.
  6. Physiotherapy can be important for cognitive and behaviour modification; and
  7. Treating the anxiety, depression, and post-traumatic stress disorder that can accompany CRPS.

The Plaintiff relied on a number of decisions for an Order that the quantum for this type of case is in the range of $200,00 to $240,000; If you are dealing with a case in which a client suffers from CRPS, these cases may be helpful:

  1. Wang v. McNaught, 2017 BCSC 454 (CanLII): A plaintiff, in his mid-40s, was involved in two motorvehicle accidents and suffered from resulting chronic pain, major depressive, and post-traumatic stress disorders, all of which were not pre-existing. The plaintiff’s chronic pain, which was likely permanent, continued to markedly impair his social and recreational life and his ability to carry out domestic chores. Before the accident, the plaintiff was described as being in the prime of his life and physically vigorous. After the accident, his home life had been disrupted, and he could no longer do the physical things he enjoyed. His future work was likely to be sedentary. The court awarded non-pecuniary damages of $175,000;
  2. Kim v. Lin, 2016 BCSC 2405 (CanLII): A plaintiff suffered accident-related soft-tissue injuries to her back and SI joints, causing her considerable pain and discomfort. Her physical pain and personal circumstances led to psychiatric disorders, fibromyalgia, and chronic pain syndrome. Although her injuries were not catastrophic, they were more than superficial and her quality of life and her ability to meet household and family responsibilities were severely affected. The court awarded non-pecuniary damages of $175,000 which, when adjusted for inflation, amounts to $176,767 in 2017;
  3. Pololos v. Cinnamon-Lopez, 2016 BCSC 81 (CanLII): A plaintiff suffered soft-tissue injuries in a motor vehicle accident which resulted in chronic pain, ongoing headaches, dizziness, and nausea, preventing him from returning to his former occupation in construction, home repairs and maintenance. The plaintiff’s perception of his pain and convictions about his disability his functionality and his circumstances. The court awarded non-pecuniary damages of $180,000 which, when adjusted for inflation, amounts to $181,818.
  4. Hans v. Volvo Trucks North America Inc., 2016 BCSC 1155 (CanLII): A 33-year-old plaintiff suffered minor physical, but significant psychological, injuries as a result of a single vehicle accident caused by fault in his tractor trailer truck engine. The court described the plaintiff’s injuries as “life altering” in every respect. Prior to the accident, the plaintiff was a gregarious, fun-loving, competitive, hard-working, ambitious, and financially driven young man with boundless energy and great strength and athletic ability. He fully participated in all aspects of his children’s lives and in household responsibilities. After the accident, he suffered from a major depressive disorder arising from PTSD and was emotionally and socially a shell of his former self. He was isolated and withdrawn, and prone to agitation and volatile bursts of anger. He had attempted suicide on three occasions, and his life was ruled by pharmaceutical and psychiatric interventions. His prognosis was “guarded at best and bleak at worst.” The court awarded non-pecuniary damages of $265,000 which, when adjusted for inflation, amounts to $267,676.
  5. Pike v. Kasiri, 2016 BCSC 555 (CanLII):  A plaintiff, 33 at the time of the accident, experienced pain and stiffness in his neck, back and knees and a sharp pain in his groin which gradually developed into a serious problem in his left hip, requiring two surgeries. Prior to the accident, he worked as a plumber and played baseball at a high level. He was a well-adjusted, outgoing, and sociable man in a happy marriage. After the accident, he was unable to work as a plumber or play baseball and, five and a half years later, still experienced considerable pain and discomfort. He also suffered from PTSD, depression and chronic main requiring medication and counselling. The court found that the accident had a profoundly negative effect on almost every aspect of the plaintiff’s life. The court awarded non-pecuniary damages of $190,000 which, when adjusted for inflation, amounts to $191,919;
  6. Manoharan v. Kaur, 2016 BCSC 692 (CanLII): A 53-year-old plaintiff, injured in a motor vehicle accident, suffered pain in her shoulders and back which led to a diagnosis of cervical strain, nerve compression, depression, anxiety, and chronic pain. Her injuries caused a substantial loss of pre-accident function, which restricted her activities and affected her relationship with her husband. She had a markedly diminished capacity to work. Her prognosis was not entirely bleak but was not favourable. The court awarded non-pecuniary damages of $170,000, which, adjusted for inflation amounts to $171,717.
  7. Cornish v. Khunkhun, 2015 BCSC 52 (CanLII): A plaintiff, injured in a motor vehicle accident, suffered from regular and ongoing post-accident headaches, pain in her neck and shoulders, and back pain. She also suffered from vertigo or dizziness and was often confused and had significant memory issues. She also suffered from a major depressive disorder and somatic symptom disorder resulting in chronic pain. Pre-accident she was an active, vibrant woman whose enjoyment of life had been significantly affected. The court awarded non-pecuniary damages of $160,000 which, adjusted for inflation amounts to $164,032.
  8. Sebaa v. Ricci, 2015 BCSC 1492 (CanLII): A motor vehicle accident significantly impacted almost all dimensions of the plaintiff’s life. The plaintiff was 33 years old at the time of the accident. The plaintiff developed a chronic pain disorder with both physical and psychological symptoms. The plaintiff was in constant daily neck, shoulder, hand, knee, and foot pain and suffered from seriously debilitating anxiety and depression. Her prognosis was pessimistic, but there was a realistic possibility that her symptoms and functioning might improve. The court awarded non-pecuniary damages of $180,000 which, adjusted for inflation amounts to $184,536;
  9. Williams v. Nelson, 2015 BCSC 1776 (CanLII): A 20-year-old plaintiff was injured in a motor vehicle accident. Prior to the accident, he was healthy, social, energetic, and physically active. He worked hard in a physically demanding job. In the five years since the accident, he suffered from very severe, debilitating pain in his neck, back, and shoulder and excruciating pain in his jaw. He underwent extensive, invasive, and painful orthodontic treatments including two surgeries. As a result of his pain, he suffered from significant, debilitating, psychological conditions. His jaw pain was incurable. His injuries very significantly affected all aspects of his life resulting in social isolation and withdrawal. He could not work which affected his self-image and caused him despair. The court awarded non-pecuniary damages of $175,000 which, when adjusted for inflation, amounts to $179,410;
  10. Scoates v. Dermott, 2012 BCSC 485 (CanLII): A plaintiff suffered horrific orthopedic injuries in an accident, followed by three subsequent accidents which exacerbated his condition. He was left with permanent disabilities and was no longer able to work as a paramedic. He suffered ongoing chronic pain, which was expected to be permanent, and experienced depression as a result of his pain, limitations, and the loss of his career. The court awarded non-pecuniary damages of $250,000 which, when adjusted for inflation, amounts to $268,100;
  11. Soligo v. Turner, 2001 BCSC 205 (CanLII), aff’d 2002 BCCA 73 (CanLII): A plaintiff’s shoulder was struck by the side-view mirror of a pick-up truck. She underwent seven surgical procedures and lived in chronic pain. She suffered from CRPS and lost the ability to follow her chosen career path and to compete in a sport in which she was internationally competitive. The court awarded non-pecuniary damages of $150,000 which, when adjusted for inflation, amounts to $198,180;
  12. Delli Santi v. Pacific National Exhibition, 2000 BCSC 716 (CanLII): A plaintiff was injured at the PNE when a wooden room divider fell and struck her on the head. When it was lifted off her, she experienced an odd sensation in her left arm. Her left hand was swollen and cold, and she felt neck pain. Her condition worsened, and she suffered from chronic, disabling pain that was probably permanent. The plaintiff described her pain as “torture” pain which was so severe she wanted to rip her arm off. Her skin was so sensitive she could not stand anyone touching it. Her arm was often swollen and felt as if it was being stung by millions of needles. As a result, she had difficulty sleeping and experienced burning rashes up her neck and under her chin. The court awarded non-pecuniary damages of $150,000 which, adjusted for inflation, amounts to $204,810; and
  13. P.O.J. v. D.Y., 1995 CanLII 2783 (BC SC), 15 B.C.L.R. (3d) 224 (S.C.): This was the only case Mr. McCaffery found which involved an assault with a baseball bat, resulting in the plaintiff suffering a disabled arm. In that case, non-pecuniary damages were agreed to be $110,000 which, when adjusted for inflation, amounts to $163,559.

The Range

[63]        The average award in the cases relied on by Mr. McCaffery is over $194,000 at today’s adjusted for inflation awards. The median award is almost $182,000. Those figures are depressed slightly by the inclusion of the consent award in P.O.J. Without it, the average is almost $197,000 and the median is just over $183,000.

Conclusion

I have concluded that an appropriate award for Mr. McCaffery’s pain, suffering, and loss of enjoyment of life is $200,000.

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