Understanding Reflex Sympathetic Dystrophy
"The railroad's doctor tells me that there is nothing wrong. But I am still in constant pain. Why?" Your problem could be a chronic neurological condition that very few doctors, and very few lawyers, will recognize.
WHAT IS REFLEX SYMPATHETIC DYSTROPHY?
Reflex Sympathetic Dystrophy (RSD), also known as Complex Regional Pain Syndrome (CRPS), is a chronic neurologic syndrome characterized by severe burning pain, changes in skin color or temperature, excessive sweating, tissue swelling and extreme sensitivity to touch.
RSD is best described in terms of an injury to a nerve, bone or soft tissue that does not follow the normal healing path. RSD is generally caused by trauma to the nervous system. Crushing injury, bone fracture, long-term nerve compression or surgery are some of the typical causes of this syndrome. A relatively minor injury, such as a sprain or a fall can cause RSD.
A characteristic of RSD is that the pain may be more severe than expected for the type of injury that occurred.
The railroader with RSD may have pain but very little objective injury. However, the railroader is not getting any better and is continuing to experience significant pain. Many lawyers may treat the RSD client as if he simply has a whiplash injury, or a broken bone. As a result, the personal injury lawyer may not properly evaluate the value of the work injury claim, and the railroader may wind up with a settlement or verdict that is substantially lower than the true case value.
THE IMPORTANCE OF EARLY DIAGNOSIS AND TREATMENT
RSD is a syndrome that may not be recognized by many doctors. Neurologists, hand surgeons and pain specialists are most likely to be aware of the syndrome. Many general practitioners and specialists who do not see patients for hand or foot pain can misdiagnose the condition. Assessment by a neurologist or pain specialist is critical. In 70% of patients, RSD will spread up the same extremity (i.e., from the hand to the arm, or from the foot to the leg). Many railroaders who are not treated early will experience the spread of RSD and this may become a life long problem.
Even with early treatment, this may be a chronic condition.
A railroader should be cared for by physicians who know how to treat RSD. Often a team approach (physician, physical therapist, anesthesiologist, mental health provider and social worker) is most helpful. Treatment may include medication, sympathetic nerve blocks, physical therapy, psychological support, sympathectomy and/or dorsal column stimulator. In severe cases, treatment should be sought from a pain clinic that offers a coordinated treatment plan.
HOW RSD AFFECTS AN INJURED RAILROADER
RSD is a complex condition with varying degrees of disability and severity. A railroader can experience permanent pain and disability. Treatment for the syndrome may be extensive, prolonged and costly. The railroader may feel like he is not improving despite medical treatment. A railroader may lose the ability to enjoy prior interests and recreational pursuits. Importantly, the syndrome can be financially devastating since the railroader may not be able to work. This can lead to depression and emotional difficulties for the railroader. It may be hard to maintain a marriage, act as parents and keep your friends when you are dealing with severe chronic pain that others may have a difficult time understanding.
These damages may be recoverable in a FELA - Federal Employers' Liability Act action, if they were caused in whole, or in part by the railroad's failure to provide you with a safe work place. It is important to consult with attorneys who specialize in FELA and know how serious RSD is. Your personal injury lawyer must be experienced with the issues related to RSD causing chronic pain and be able to obtain effective experts to give testimony. Making the connection between the railroad work injury and RSD, and conveying the full impact of the syndrome on the railroader's life, are key to recovering adequate money damages.