Dr. Greg Vigna discusses Complex Regional Pain Syndrome Type 1 (CRPS) and the suggested relationship to crush injuries.

The cause of the pain from Reflex Sympathetic Dystrophy (RSD), now referred to as Complex Regional Pain Syndrome Type 1 (CRPS) is unknown but recent animal models suggest that it is related to impairment in blood flow that occurs in crush injuries and significant soft tissue sprains as arterial pressure cannot perfuse injured tissues. This leads to activation of muscle pain receptors and sensory activation of pain nerve fibers.

“Crush injuries to the feet and hands have a disproportional incidence of Complex Regional Pain Syndrome likely related to deep-tissue microvascular pathology.” — Dr. Greg Vigna

The mechanism of pathogenesis is believed to include the following:

  1. Deep tissue injury produces acute inflammation with edema
  2. Compartment-like syndrome where arterial blood supply is blocked by pressure caused from edema
  3. Slow flow or no flow arterial blood flow
  4. Ongoing deep tissue ischemia (lack of blood flow) and ongoing inflammation
  5. Nerve and muscle/bone sensitization and abnormal nerve discharge
  6. Pain, allodynia, burning

CRPS Type 1 is a rare chronic pain syndrome that occurs following sprains, crush injuries, and fractures that produce ongoing neuropathic pain in the absence of nerve damage. Pain is described as aching and burning with a consistent finding of allodynia where simple touching is interpreted as pain. Pain persists far longer than one would expect for an uncomplicated soft tissue injury, crush injury, or fracture. Patients require early diagnostic and therapeutic sympathetic blocks and active physical and occupational therapy to desensitize the painful extremity.

Greg Vigna, MD, JD, practicing physician, national neurological injury lawyer, and Certified Life Care Planner states, “We have clients who have sustained crush injuries who come to my law firm as we understand both the life altering aspect of this injury but also the cost of necessary care for the injured person to their life expectancy. Treatment includes sympathetic nerve blocks, physical and occupational therapy, spinal stimulators, medication management, and psychological support.”

Dr. Vigna adds, “Our lawyers dig deep into the cause of the injury as many times there is a defective product such as a forklift or other work vehicle that fails or a dangerous machine that places the machine operator at unreasonable risk of crush injuries to their hands. Findings after investigation can provide other sources for damages outside worker’s compensation-remains other sources that have caps on damages. Our product liability lawyers understand the realities of finding all responsible parties that acted negligently as our client’s financial survival may depend on our obtaining the compensation they need and are entitled to.”

Dr. Vigna concludes, “We want our clients to get the best medical care as we recognize the serious and life altering aspect of this diagnosis.”

Dr. Vigna is a California and Washington DC lawyer who focuses on catastrophic neurological injuries caused by transvaginal mesh devices including pudendal neuralgia, obturator neuralgia, ilioinguinal neuralgia, and Complex Regional Pain Syndrome. He also focuses on products liability and medical negligence. He is a stroke expert and national malpractice attorney. His cases are filed around the country with Martin Baughman, a Dallas Texas firm. Ben Martin and Laura Baughman are national pharmaceutical and products liability injury trial attorneys in Dallas, Texas.

Reference: https://academic.oup.com/painmedicine/article/11/8/1224/1856104

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Greg Vigna, MD, JD
Vigna Law Group
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