Is CRPS Diagnosed Too Quickly?
Greetings everyone. I’m a 28-year-old man grappling with chronic pain stemming from a traumatic incident when I was struck by a van at sixteen, resulting in a multifaceted bicondylar tibial plateau fracture, along with complications such as compartment syndrome that required fasciotomy. In 2014, I underwent an electromyography procedure where the neurologist indicated I had neuropathy. After consulting a pain specialist, he diagnosed me with Complex Regional Pain Syndrome (CRPS). However, several aspects of this diagnosis raised concerns for me. Firstly, I discovered that CRPS is recognized primarily as a diagnosis of exclusion, yet the specialist provided this diagnosis within one or two visits. Secondly, based on the electromyography in 2014, I had already been diagnosed with neuropathy by a neurologist, which seems to contradict the new diagnosis. Thirdly, the pain doctor failed to clarify whether my condition is classified as type 1 or type 2 CRPS. My current pain management physician is aligned with my previous diagnosis of peripheral neuropathy resulting from my motor vehicle collision, which appears to be the most logical explanation. From my understanding, CRPS is generally applied in scenarios where the injury evidence is ambiguous or when pain levels seem to exceed what would be expected from the original injury. Literature often discusses this condition using terms like exaggeration and links it to psychogenic pain or somatization. Thus, I’m curious to hear opinions from medical professionals here: is CRPS typically reserved for patients with questionable injury cases? And if it is indeed a diagnosis of exclusion, doesn't it seem a bit premature to receive that diagnosis so swiftly from the pain specialist?
Answers (1)
3/17/2025, 10:00:50 PM
OpenHealth AI
It's understandable to feel unsettled about the diagnosis of Complex Regional Pain Syndrome (CRPS), especially given your medical history and concerns about the process behind that diagnosis. Let's break down your situation and clarify some important points regarding CRPS and its diagnostic criteria.
Key Points:
- Diagnosis of CRPS: CRPS is indeed considered a diagnosis of exclusion, and it usually requires a thorough assessment of symptoms and history.
- Types of CRPS: There are two types; Type 1 occurs without identifiable nerve damage, while Type 2 is associated with a specific nerve injury. Clarity on which type applies to you is crucial.
- Existing Diagnoses: Your previous diagnosis of neuropathy added complexity to your pain management, which is important to communicate with your healthcare providers.
Explanation:
CRPS can be complicated and often involves pain that is disproportionate to the initial injury. The criteria for diagnosing CRPS include:
- The presence of an initiating event (like your trauma).
- Ongoing pain that is either constant or episodic and exceeds typical expectations for the injury.
- Symptoms such as changes in skin color, temperature, and swelling.
Diagnosing CRPS quickly can occur when a physician recognizes these symptoms, but it's essential to ensure that other potential explanations, like neuropathy, are adequately ruled out or understood.
Next Steps:
- Seek Clarity: Request a follow-up appointment with your pain management physician to clarify the CRPS diagnosis. Specifically, ask about which diagnostic criteria were used and whether it aligns with your history of neuropathy.
- Consider Referrals: If uncertainties persist, consider seeking a second opinion from another pain specialist or a neurologist experienced in CRPS. They can have a fresh perspective on the integral aspects of your case.
- Document Everything: Keep a detailed record of your symptoms, treatments, and responses to them. This information can support discussions with your healthcare providers and guide their understanding of your condition over time.
- Educate Yourself: Learn more about CRPS through reputable sources such as the American Chronic Pain Association or relevant medical literature, which can provide insight into the condition and potential management strategies.
You deserve clarity about your diagnosis and the most effective treatment plan. Keep advocating for your health, and ensure open lines of communication with your healthcare team. If you have further concerns or need more specific advice on managing pain, feel free to reach out.
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Should this be a cause for concern? Is there a prospect for it to normalize post shunt closure?** 3. **Are the hemangiomas/nodules (11.6×20.7 mm) linked to the shunt? Will they likely resolve following shunt repair?** 4. **How urgent is the proposed intervention? Is immediate action required, or is there flexibility to wait a few months?** 5. **What complications should we be vigilant for during the waiting period?** 6. **Regarding endovascular closure - what is the average success rate for infants aged 7 months? Are there concerns regarding the shunt size (9.9 mm)?** 7. **The measurement of the portal vein has shown improvement from 6.1 mm to 3.9 mm; should this be perceived as a positive sign or a reason for concern?** 8. **Are there special directives (diet modifications, medications) we should consider while awaiting the procedure?** 9. **Post-procedure, how long should we expect it might take for:** - Normalization of bilirubin levels? - Return of stool color to normal? - Resolution of jaundice? - Regression of hemangiomas? 10. **Can you recommend any specialized centers for pediatric Abernethy malformation treatments? We are located in Uzbekistan but are prepared to travel (to Turkey, Russia, South Korea, etc.)** --- ## ADDITIONAL INFORMATION - No family history of hepatic diseases - Pregnancy and delivery were normal - No additional congenital defects identified - Immunizations up to date - No history of bleeding disorders - No signs indicative of encephalopathy - Child is alert and engaged --- **I can supply actual MSCT images and comprehensive lab reports if they would be of assistance.** We sincerely appreciate any insights you can provide. We are striving to make the most informed decision regarding our daughter’s care and highly value expert medical opinions. **TL;DR:** 7-month-old diagnosed with Abernethy Type 2 malformation (9.9 mm portocaval shunt, patent portal vein). Liver functionality is improving (normalized ALT) while bilirubin remains elevated (242). Evaluating options between endovascular coil embolization and open surgery. Seeking expert advice on optimal treatment strategy and timing.