Complex Regional Pain Syndrome (CRPS) is one of the most complicated medical conditions not only for physicians but also lawyers. The disease is characterized by invisible imaging tests, different rates of progression among patients and the high role of clinical diagnosis, which makes it one of the hardest cases in the court of law. In the context of personal injury, workers’ compensation or medical malpractice lawsuits, the selection of a qualified CRPS expert witness becomes crucial in terms of the construction of evidence.
CRPS Understanding: Reasons for Complex Litigation of the Case
This condition usually occurs after injuries, surgeries and even minimal traumas, and is characterized by disproportionate and prolonged pain together with changes in skin color, temperature and swelling of the affected limb. There is no laboratory test that can prove CRPS, so the condition is diagnosed according to the Budapest criteria, which is a system of signs and symptoms used by pain experts around the world, described at NCBI/StatPearls.
However, in cases where the judges and juries have no knowledge of this condition, such diagnostic nuances can raise many questions. The main argument raised by defense lawyers is always that CRPS symptoms are exaggerations, psychological or not relevant to the particular accident at all. And this is precisely why a good expert witness for Complex Regional Pain Syndrome is needed — to bring clinical subtleties to the language understandable and comprehensible for the court and jury.
CRPS Expert Witness: What Does He Do
The role of a pain management expert witness in a CRPS case usually includes:
- Verification of medical records to prove the legitimacy of the diagnosis based on the accepted criteria
- Causation — proving the connection between the CRPS diagnosis and the particular accident or injury
- Prognosis — determining the possible course of the disease and its effects on the patient’s life and work capacity
- Calculating the cost of further treatment, including interventions, medications and rehabilitation
- Deposition and testimony in court, withstanding the cross-examination from the opposing attorney
It is also completely different from the treating physician’s responsibilities.
The Importance of Medical Credibility in Cases of CRPS
Since CRPS is often vigorously contested compared to other types of injuries, the credibility of the medical expert himself is quite important. In choosing such an expert, one must consider:
- The board certification in the corresponding field (pain medicine, anesthesia, or neurology)
- The clinical experience of working directly with CRPS patients (not merely theoretical knowledge of this disease)
- A history of research works on trauma physiology, pain syndromes, or their interventions
- Previous participation in trial testimonies or depositions
It’s all present in the case of Dr. Eugene Lipov. A board-certified doctor and researcher known as the founder of the clinical application of Stellate Ganglion Block (SGB) and one of the co-founders of Dual Sympathetic Reset (DSR), which aims at correcting the sympathetic nervous system disorder due to trauma, his expertise is inextricably linked to the physiology at the core of many cases of CRPS. This gives him the possibility to prove not only the existence of the disease but its cause and progression as well.
For an in-depth analysis of the treatment modality concerning nervous system dysfunction, refer to the following: Sympathetic Nervous System Dysfunction Symptoms: Signs, Causes, and Its Relationship with Trauma.
What Attorneys Need to Ask Before Engaging a CRPS Medical Expert Witness
Before engaging a pain management expert witness in a CRPS lawsuit, it may be worthwhile to ask the following:
- Has this expert worked on treating CRPS patients personally, or just looked at other experts’ cases from the sidelines?
- Is he or she capable of giving a clear understanding of the Budapest Criteria and its application to the current patient?
- Does the expert have any published material or research in his or her support of his/her clinical opinions
- Has the expert testified in the past and how have his/her opinions held out under cross-examination?
Answering “yes” to all four questions is likely to indicate that the expert will help rather than hinder the case.
Frequently Asked Questions
What is the distinction between CRPS Type 1 and Type 2? In CRPS Type 1, there is no proven nerve damage whereas in CRPS Type 2 there is. But both are evaluated through the same Budapest Criteria.
Can there be any proof of CRPS in court without imaging or laboratory testing? Yes. As there is no one test to confirm CRPS, diagnosis and legal causation in most cases are based on clinical history documentation, Budapest Criteria, and medical testimony by an expert in CRPS.
Which cases usually need the help of a CRPS expert witness? The most common cases requiring the testimony of a CRPS expert witness include personal injury cases, workers’ compensation claims, and cases of medical malpractice, where the issue of the diagnosis or its causation is under dispute.
How is the future treatment cost of CRPS estimated in a legal case? The future cost of treatment is estimated by an expert witness based on the patient’s current treatment regimen, disease progression, and typical interventions for CRPS, such as sympathetic blocks, medications, and physical therapy.
Further Reading
Sympathetic Blocks for Dual Trauma and PTSD Recovery: What Patients Should Know
How Does SGB Bring Relief When Other PTSD Treatments Fail?
Get in Contact
Dr. Eugene Lipov offers medical-legal consultation as an expert witness in CRPS and pain management for lawyers dealing with cases involving complex regional pain syndrome and chronic pain. For inquiries or to arrange for a consultation, contact him here o read more about his expertise as a medical-legal consultant.