- Chronic pain
- Complex regional pain syndrome
The worker suffered a low back injury in December 1996, for which the Board granted the worker a 19% NEL award. He suffered a left shoulder injury in July 2004. The worker appealed a decision of the Appeals Resolution Officer denying entitlement for the left shoulder and neck as a result of the 1996 accident, denying entitlement for the neck and hands in March 2011 on a disablement basis, and denying entitlement for complex regional pain syndrome (CRPS) as a result of any of the accidents.
On the evidence, the worker had entitlement for the left shoulder as a secondary condition resulting from the 1996 accident, did not have entitlement for a recurrence of the left shoulder condition in April 2005, and had entitlement for the neck and hands in 2011.Generally, CRPS (formerly known as reflex sympathetic dystrophy) is a specific diagnosis that has been recognized by Tribunal decisions and is distinct from chronic pain disability. It is discussed in the Tribunal's medical discussion paper on Complex Regional Pain Syndrome – Type 1 (CRPS1). It is described as having distinct physical features, which typically occur as a consequence of limb trauma, with an unknown or disputed etiology. The discussion paper sets out proposed diagnostic criteria, which have been codified by the International Association for the Study of Pain (IASP): an initiating noxious event or cause of the immobilization; continuing pain, allodynia or hyperalgesia disproportionate to the inciting event; evidence of edema, changes in skin blood flow or abnormal sudomotor activity in the region of pain; and exclusion by the existence of other conditions that would otherwise account for the degree of pain and dysfunction. Thus, while the diagnostic criteria include chronic and disproportionate pain in common with chronic pain criteria, there are requirements for specific physical findings, such as edema or changes in skin blood flow, which are not required when considering entitlement for chronic pain disability under Board policy.Tribunal decisions have considered chronic pain disability as an alternative for CRPS where chronic pain disability has been claimed and decided by the Board. That is not the case in this appeal, where the worker did not make a claim at the Board for chronic pain disability and the Board did not adjudicate the claim for CRPS under the chronic pain disability policy.Chronic pain disability is a potentially broader category of entitlement than CRPS. The Vice-Chair also noted that the discussion paper does not treat CRPS as a form of chronic pain disability; rather, it is the successor diagnosis to regional sympathetic dystrophy and may have an organic etiology.The ARO decision decided only the issue of entitlement for CRPS, and not entitlement for chronic pain disability.The worker's pain condition in this case involves his back, bilateral upper extremities and bilateral lower extremities. Widespread pain is not typical of CRPS. The Vice-Chair found that the medical evidence did not favour a diagnosis of CRPS. Accordingly, the worker did not have entitlement for CRPS.The Vice-Chair made no finding on entitlement for chronic pain disability, as this was not an issue on the appeal.The appeal was allowed in part.