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Do You Have Complex Regional Pain Syndrome?

Proposed Clinical Diagnostic Criteria for CRPS

History

Resources for Military Personnel and Veterans

Recent News

Research Articles

Clinical Trials

Do You Have Complex Regional Pain Syndrome (CRPS)?
CRPS was previously referred to as Reflex Sympathetic Dystrophy (RSD)

Question 1: Do you have lasting pain that is out of proportion to an injury?  Does the pain hurt more than you think it should?  

Question 2: If so, do you have any of the following additional symptoms?

  1. intense pain to non-noxious stimuli, such as being touched by clothing, or bath water
  2. strange changes in skin color or skin temperature (your skin may turn blue or red, hot or cold, in the affected area of the body)
  3. excessive sweating in an affected area of the body, or sweating for no reason at all 
  4. tissue swelling (edema) in the affected area
  5. weakness or movement problems in the affected area
  6. changes in hair growth or nail growth in the affected area

If you answered Yes to both Questions 1 and 2, you should print out the following information for your doctor. This information will help your doctor clarify whether you have Complex Regional Pain Syndrome.

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Proposed Clinical Diagnostic Criteria for CRPS
Budapest Consensus Group

1) Continuing Pain, which is disproportionate to any inciting event

2) Must report at least one symptom in three of the four following categories:

Sensory: Reports of hyperesthesia and/or allodynia

Vasomotor: Report of temperature asymmetry and/or skin color changes and/or skin color asymmetry

Sudomotor/Edema: Reports of edema and/or sweating changes and/or sweating asymmetry

Motor/Trophic: Reports of decreased range of motion and/or motor dysfunction (weakness, tremor, dystonia) and/or trophic changes (hair, nail, skin)

3) Must display at least one sign* at time of evaluation in two or more of the following categories:

Sensory: Evidence of hyperalgesia (to pinprick) and/or allodynia (to light touch and/or deep somatic pressure and/or joint movement)

Vasomotor: Evidence of temperature asymmetry and/or skin changes and/or asymmetry

Sudomotor/Edema: Evidence of edema and/or sweating changes and/or sweating asymmetry

Motor/Tropic: Evidence of decreased range of motion and/or motor dysfunction (weakness, tremor, dystonia) and/or trophic changes (hair, nail, skin)

4) There is no other diagnosis that better explains the signs and symptoms

*A sign is counted only if it is observed at time of diagnosis.


Further information about the symptoms and signs of CRPS

CRPS: Practical Diagnostic and Treatment Guidelines, 4th Edition (PDF)

Complex? Regional? Pain? Syndrome? (PDF)
Schott GD. Practical Neurology. 2007;7:145-157.

National Institutes of Health: CRPS Fact Sheet

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History

CRPS was first described by Dr. Silas Weir Mitchell, a Union Army Surgeon, in 1864 after having witnessed the experience of injured soldiers in the Civil War. The suffering of one particular soldier with CRPS is described in some detail.

On the second day the pain began. It was burning and darting. . . . sensation was lost or lessened in the limb, and . . . paralysis of motion came on in the hand and forearm. The pain was so severe that a touch anywhere, or shaking of the bed, or a heavy step, caused it to increase.

Two years later the pain was still at the level where the soldier could not tolerate 'Friction of the clothes, at any point of the entire surface . . .' as this 'shoots into the hand' increasing his burning pain. He would allow no one to touch him 'except with a wetted hand, and even then is careful to exact careful
manipulation.'

Injuries of nerves and their consequences (PDF)
Mitchell SW. Philadelphia: Lippincott; 1872;292–296.

Further information on the History of CRPS

Complex? Regional? Pain? Syndrome? (PDF)
Schott GD. Practical Neurology. 2007;7:145-157.

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Resources for Military Personnel and Veterans

Unfortunately, we are finding more and more veterans who suffer from chronic pain and who have limited financial resources.

MilitaryVALoan.com is a free resource for military veterans researching VA home loans and other mortgage related benefits available to them. An independently owned, non-government site offering up-to-date information on current VA mortgage rates, purchase and refinance guides, eligibility information, energy efficiency opportunities, and more.

Military and Veterans with RSD/CRPS Facebook Group

Military OneSource provides centralized support, 24/7, for injured service members and their families.

Wounded Soldier and Family Hotline works hand in hand with MEDCOM and base hospitals to help veterans get the care they need. The toll-free phone number is 800-984-8523.

Unavailability of VA Medical Facilities or Services? Non-VA Care could be the answer!
If a Veteran is eligible for certain medical care the VA hospital or clinic should provide it as the first option. If they can’t – due to a lack of available specialists, long wait times, or extraordinary distances from the Veterans home the VA may consider Fee Basis care.www.nonvacare.va.gov/

Returning from the War Zone: A Guide for Military Personnel is a guide for service members returning from deployment. It contains information to help military personnel understand what to expect when returning from a war zone, and to help them to better adapt back to home life. There is also a guide for family members: Returning from the War Zone: A Guide for Families of Military Personnel

Exit Wounds: A Survival Guide to Pain Management for Returning Veterans and Their Families
By Derek McGinnis, Iraq War Veteran, with Stephen R. Braun
Hundreds of thousands of troops are returning from the wars in Iraq and Afghanistan, many of them in acute pain and facing the possibility of a lifetime of chronic pain. Written by a wounded Iraq war veteran in collaboration with the American Pain Foundation, Exit Wounds and its companion website, offer veterans and their families need-to-know information.

The National Resource Directory (NRD) is an online tool for wounded, ill and injured Service Members, Veterans, their families and those who support them. The NRD provides access to thousands of services and resources at the national, state and local levels that support recovery, rehabilitation and community reintegration.

Maintained by the Departments of Defense, Labor and Veterans Affairs, the NRD links to federal and state government agencies; Veterans service and benefit organizations; not-for-profit and community-based organizations; academic institutions and professional associations who provide assistance to wounded warriors and their families.

The Military Family Network supports military families and increases their readiness and well-being by connecting them with their communities and the organizations that provide the best service and value.

Military families transition frequently and are not afforded the same advantage as long-term residents in accumulating community information and knowledge. The Military Family Network connects military families with each other and the best of what the community has to offer. They provide a network that connects families with businesses and organizations who have quality products and services and have demonstrated a sincere interest in creating or sustaining relationships
with the military.

Veterans Affairs Caregiver Support: Caring for Those Who Care
Includes information on VA Caregiver Services and New Family Caregiver Support Program. If you are a caregiver and need assistance call National Support Line: 1-855-260-3274.

Call our hotline at 800-313-4200.   My HealtheVet (MHV) is the gateway to Veteran health benefits and services. It provides access to health information, links to Federal and VA benefits and resources, the Personal Health Journal, and online VA prescription refills.

Federal Benefits for Veterans, Dependents and Survivors

The Department of Veterans Affairs Vet Center program operates a system of 232 community based counseling centers. The Vet Centers are staffed by small multidisciplinary teams of dedicated providers, many of which are combat veterans themselves. Vet Center staff are available toll free during normal business hours at 800.905.4675 (Eastern) and 866.496.8838 (Pacific).

Vet Centers provide readjustment counseling and outreach services to all veterans who served in any combat zone. Services are also available for their family members for military related issues. Veterans have earned these benefits through their service and all are provided at no cost to the veteran or family.

The National Veterans Foundation connects veterans and their families with vital services—everything from crisis counseling and benefits assistance to transportation and job training. One of the cornerstones of the Foundation’s outreach is called Lifeline for Vets, a toll-free number, 888.777.4443, that immediately connects vets and family members with a trained counselor and fellow veteran, 12 hours a day, seven days a week.
Contact:
National Veterans Foundation
9841 Airport Blvd Suite 418
Los Angeles, CA  90045
Tel: 310.642.0255
Toll-free: 888.777.4443
Fax: 310.642.0258
E-mail

Disability.gov: Benefit Programs for Veterans & Military

Physical Evaluation Board Forum

Employment Resources

Veteran Outreach at the Department of Homeland Security
The Department of Homeland Security is proud to count 47,000 veterans—25% of all civilian employees—among its workforce, with a goal of increasing that number to 50,000 by 2012. In addition, in each of the past two years the Department has awarded approximately $900 million in prime contracts to non-disabled and service disabled veteran owned small businesses.

The Career Center for Combat Wounded and Disabled Veterans is a collaboration of the DoD and www.military.com that provides an online Career Center designed to connect severely injured service members with benefits, resources, and employment opportunities to help ease their transition.

Veterans with Service-connected Disabilities in the Workplace and the Americans with Disabilities Act (ADA)

The Recovery and Employment Assistance Lifelines (REALifelines) Advisor provides veterans and transitioning service members wounded and injured as a result of the War on Terrorism, and their family members, with the resources they need to successfully transition to a rewarding career.

Developed by the U.S. Department of Labor's Veterans' Employment and Training Service (VETS), the REALifelines Advisor provides valuable information and access to contact information for one-on-one employment assistance and online resources to assist wounded and injured transitioning service members and veterans in their reintegration into the civilian workforce. While this site is intended for use by wounded and injured transitioning service members, it offers extensive information and resources that can benefit all veterans.

Job Opportunities for Disabled American Veterans
disABLEDperson Inc. has launched a new website to provide employment resources to Wounded Warriors. disABLEDperson Inc. is a public charity, founded in 2002, that works under the mission of providing employment opportunities to Americans with disabilities.

Job Opportunities for Disabled Veterans aims to directly decrease unemployment by opening networks for communication between potential employers and prospective hires. On the site, Veterans can access over 5,000 job listings throughout the country, set up a personal profile with a customizable resume for direct submission to hiring companies, and find resources to assist in professional development as one goes through the process of identifying and applying for a job.

Military Aid Societies

The following societies can offer veterans and their families emergency relief.

Army Emergency Relief (AER) is a private not-for-profit organization to help soldiers and their dependents. AER is the Army's own emergency financial assistance organization and is dedicated to "Helping the Army Take Care of Its Own." AER funds are made available to commanders having AER Sections to provide emergency financial assistance to soldiers—active and retired—and their dependents when there is a valid need.
Contact:
Army Emergency Relief
200 Stovall Street
Alexandria, VA 22332
Tel: 703.428.0000
Toll-free: 866.878.6378
Fax: 703-325-7183
General: aer@aerhq.org
Assistance: assistance@aerhq.org

Air Force Aid Society (AFAS) provides emergency assistance in the form of an interest free loan, a grant, or a combination of both. A grant or combination loan/grant can be given when repayment would cause a genuine hardship, but is not given to reward financial irresponsibility. Grants are sometimes given for basic needs; eg, food, utilities, emergency travel, medical or dental expenses, but they are not normally used for rent, vehicle repairs, moves, or education. Unique cases should be coordinated with AFAS headquarters. AFAS Sections are located at all Air Force Bases, worldwide. Most are located in the Airman & Family Readiness Center.

Coast Guard Mutual Assistance is a not-for-profit organization providing financial assistance to the Coast Guard community. For more information, contact your nearest CGMA representative, call 800.881.2462, or e-mail ARL-DG-CGMA@uscg.mil.

Navy-Marine Corps Relief (NMCRS) is a not-for-profit, charitable organization that provides financial, educational, and other assistance to members of the Naval Services of the United States, and their eligible family members and survivors, when in need. To do this, counseling, loans, grants, various services, and referral to other community resources are available. There are no fees for such help. The Society, operating in partnership with the Navy and Marine Corps, administers nearly 250 offices ashore and afloat at Navy and Marine Corps bases around the world.
Contact:
Navy-Marine Corps Relief Society
875 North Randolph Street, Suite 225
Arlington VA 22203-1977
Tel: 703.696.4904
Fax: 703.696.0144
Locations

Other Nonprofit Organizations that Assist Veterans

Disabled American Veterans (DAV) National Service Foundation develops financial resources for the assistance, aid, maintenance, care, support. and rehabilitation of disabled veterans and their dependents, either directly or by contributions to the service programs of the Disabled American Veterans National Organization or its Departments and Chapters.
Contact:
Disabled American Veterans National Service Foundation
3725 Alexandria Pike
Cold Spring, KY 41076
Toll-free: 877.426.2838

The American Legion offers temporary financial assistance (TFA) to keep the children of diseased or disabled veterans at home rather than institutions. The TFA fund has been used to help families meet the costs of shelter, food, utilities, and health expense items when the parents are unable to do so, thereby keeping the child, or children, in a more stable home environment. Click here to locate your local post.

American Red Cross works with the military aid societies (Army Emergency Relief, Navy Marine Corps Relief Society, Air Force Aid Society and the Coast Guard Mutual Assistance). This partnership helps to provide financial assistance for emergency travel that requires the presence of the service member or his or her family, such as the burial of a loved one. The Red Cross also facilitates assistance that cannot wait until the next business day, such as food, temporary lodging, urgent medical needs, or funds to avoid eviction, utility shut off.

Angel Flight for Veterans provides no-cost or greatly reduced costs of long-distance, charitable medical transportation travel for people who need distant specialized medical evaluation, diagnosis or treatment. Veterans, active duty military personnel and their families are eligible.
Contact:
4620 Haygood Road, Ste. 1
Virginia Beach, VA 23455
Toll-free: 800.296.1217
Fax: 800.550.1767
E-mail: info@angelflightveterans.org

Air Compassion for Veterans ensures that no financially-stressed wounded warrior / veteran / active duty military person or their family member(s) is denied access to distant specialized medical evaluation, diagnosis, treatment, or rehabilitation for lack of a means of long-distance medical air transportation. ACV is committed to the ongoing healing process of our wounded warriors and will provide transport for activities that aid in the process as long as needed.

Elks National Veterans Service Commission
In each of the 172 VA Medical Centers there is an Elk committee at work to help veterans in need, including those who are homeless.
Contact:
BPO Elks of the USA
2750 N. Lakeview Avenue
Chicago, IL 60614-1889

The Healing Heroes Network provides quality medical care to the men and women of the armed forces injured in the line of duty on or after 9/11/01. Through a nationwide network of medical professionals willing to provide services, Healing Heroes Network treats these brave warriors free of charge, for services not covered, or delayed under the U.S. Department of Veteran Affairs benefits system.
Contact:
Healing Heroes Network
31640 U.S. Hwy 19 N. Suite #2
Palm Harbor, FL 34684
Tel (Local): 727.781.HERO (4376)
Tel (Toll Free): 877.470.HERO (4376)
Fax: 727.786.6588
info@healingheroes.org

The Independence Fund works to provide necessary tools and therapies that are otherwise not being provided, fund and promote physical and leisure/athletic activities that enhance the veteran’s physical and emotional well-being, and advocacy/case management.
Contact:
Tel: 434.409.0506
Online: http://www.independencefund.org/

The National Coalition for Homeless Veterans (NCHV) is the resource and technical assistance center for a national network of community-based service providers and local, state, and federal agencies that provide emergency and supportive housing, food, health services, job training and placement assistance, legal aid, and case management support for hundreds of thousands of homeless veterans each year. The organization offers help in housing, health, substance abuse and mental health treatment, employment, general assistance, financial, and legal assistance.

Every VA medical center has a Homeless Veteran Services Coordinator charged with helping homeless or at risk veterans. To find the VA Medical Center serving your area, look in the blue pages of the phone book under "United States Government, Veterans Affairs," call the VA (toll-free) at 877.222.8387, or visit the website. For other requests, call 800.838.4357 (800-VET-HELP)

The National Association of Hospital Hospitality Houses, Inc. is a not-for-profit corporation serving facilities that provide lodging and other supportive services to patients and their families when confronted with medical emergencies. Each facility assures that a homelike environment is provided to persons who must travel to be with a patient or to receive necessary outpatient care. Contact:
NAHHH Inc.
P.O. Box 18087
Asheville, NC 28814-0087
Tel: 828.253.1188
Toll-free: 800.542.9730
Fax: 828.253.8082
E-mail: helpinghomes@nahhh.org

USA Cares
USA Cares exists to help bear the burdens of service by providing post-9/11 military families with financial and advocacy support in their time of need.

National Association of Veterans Advocates, Inc. (NOVA) develops and encourages high standards of service and representation for all persons seeking benefits through the federal veterans benefits system.
Contact:
NOVASM
1425 K Street, NW, Suite 350
Washington,DC 20005
Toll-free: 877.483.8238

The National Veterans Legal Services Program (NVLSP) is an independent, not-for-profit, charitable organization acting to ensure that the US government honors the pact made with our 25 million veterans. They provide Advocacy and Training, Education and Publications, and Pro Bono Litigation. NVLSP also recruits, trains, and assists thousands of volunteer lawyers and veterans’ advocates. Their publications empower veterans, their families and their advocates to obtain the benefits they’re entitled to by clearly outlining their rights under the law.

The Veterans of Foreign Wars of the United States: Military Assistance Program (MAP) is a quality-of-life initiative that focuses on easing the financial emergencies of deploying service members and supporting them and their family through the hardships of deployment. MAP also provides one-time grants up to $500 to service members needing emergency financial assistance. In addition, MAP has forged partnership with various service providers, including vetjobs.com, aimed at providing service members with relocation and employment assistance. Annually, VFW service officers process thousands of veteran's claims, which have resulted in the recovery of hundreds of millions dollars in disability compensation claims for veterans. Service officers, who must pass rigorous testing and annual certification, also assist veterans in discharge upgrades, record corrections, education benefits and pension eligibility.
Contact:
MAP office
Tel: 816.756.3390, ext. 211
Fax: 816.968.1149
E-mail: map@vfw.org ATTN: Veteran Services

The VFW National Home for Children has more than 85 years of experience helping military and veterans’ families by providing counsel, support and connections with resources nationwide. http://www.vfwnationalhome.org/page.aspx?pid=41
call our hotline at 800-313-4200 

Easter Seals
With generous funding from the McCormick Foundation, Easter Seals has launched a community reintegration program, Community OneSource, as part of the Foundation's Welcome Back Veterans Initiative to provide information, resources, and direct supports as well as establish an infrastructure that provides community leadership that responds directly to the needs of wounded veterans and their families as they reintegrate back into their home communities throughout greater Chicagoland. For more information about Community OneSource, please call 312.726.6200.

Easter Seals Iowa is providing veterans and their families throughout the state with in-home assistance including vocational rehabilitation assessments, recommendations for home modification and accessibility, medicine management, Web-based community engagement and traumatic brain injury rehabilitation.

Easter Seals New Hampshire is operating an innovative initiative, called Veterans Count, that works in partnership with federal, state and local resources. Together, public and private organizations are forging connections where they haven't existed before to connect veterans and their families to services that meet their medical, social, emotional and financial needs. Solutions are family-focused and address unique struggles of military families during deployment, upon returning home and continuously throughout community reintegration.

Job Training and Employment
Nationwide there are over 24 million veterans, with more than 700,000 unemployed in any given month. Adding to these numbers are the 1.6 million service members returning home from deployments to Iraq and Afghanistan. Many with newly acquired disabilities are facing significant occupational barriers as they reintegrate back into their home communities.

With more than 59 Easter Seals affiliates providing workforce development services in 140 centers in 39 states, major corporate sponsors are exploring strategies with Easters Seals Headquarters to hire veterans with disabilities throughout their organizations nationwide. Easter Seals affiliates across the country are piloting projects that facilitate employment for veterans with disabilities through a variety of models.

The McCormick Foundation has helped to underwrite Easter Seals' Operation Employ Veterans, a year-long program that supports the Foundation’s Operation Healing Freedom campaign, providing training to employers on effective methods to recruit, employ, and retain wounded veterans across the Chicagoland area. For more information about Operation Employ Veterans, please call 312.726.6200 or contact Easter Seals.

Easter Seals in Indianapolis, Ind., and Great Falls, Mont., provide vocational evaluations and assessments as well as job placement for veterans with disabilities. Easter Seals Southern Nevada provides a comprehensive array of services to veterans, through contracts with the local Department of Veterans Affairs. These services include vocational evaluations, computer training, job training, independent living evaluations, occupational therapy, and other related services.

Easter Seals East Georgia provides vocational evaluations, computer training, and job training skills, such as fork lift certification to veterans. They also are providing services to homeless veterans.

Adult Day Services
Nationwide, there are more than 6 million veterans 65 years of age or older, creating an ever more critical need for direct services as they approach the end of their lives. Most Easter Seals adult day service centers have contracts with the Department of Veterans Affairs (VA) to provide adult day services to older veterans and veterans with disabilities, specifically younger veterans with significant injuries. Adult day services are one of several long-term care benefits that veterans are entitled to under the Millennium Healthcare Act. Adult day services are a critical service for veterans and help to provide both therapeutic and social benefits for both older veterans and younger veterans with disabilities.

At the national level, Easter Seals has worked with the VA's Central Office to improve contracting processes for adult day services and have consulted on revisions of the adult day services contracting guidelines. We also are working to educate the adult day industry as a whole about how to become better service providers to veterans and a better contracting partner to the Department of Veterans Affairs.

Easter Seals Greater Washington-Baltimore Region offers adult day services to veterans at its Hagerstown and Baltimore, Md., facilities as well as a newly built intergenerational facility delivering targeted services in Silver Spring, in close proximity to Walter Reed Army Medical Center and the Veterans Affairs Medical Center in Washington, D.C.

State Programs

Check with your individual state government for special funds for veterans in need.

The Veterans Service Commission in Ohio was established on May 19, 1886, for the purpose of assisting Honorably Discharged Veterans and their minor children, spouse, and widows who have met with an unexpected hardship resulting from lack of employment, illness or injury. Click here for more information
Contact:
Veterans Services Commission
1849 Prospect Ave., 2nd Floor
Cleveland, Ohio 44115
Tel: 216.698.2600
Fax: 216.698.2650

The Michigan Veterans Trust Fund (MVTF) grants temporary assistance for emergencies or hardships to eligible wartime veterans and their families residing in Michigan. The MVTF does not provide assistance for long-term problems or chronic financial difficulties.
Contact:
Michigan Department of Military and Veterans Affairs
Veterans Benefits: 517.335.6523
Veterans Trust Fund: 517.373.3130
E-mail: hessh@michigan.gov

State of Connecticut Soldiers, Sailors, and Marines Fund administered by The American Legion, this fund was established to assist needy wartime veterans and their families It helps with rental payments, mortgage interest payments, utilities (gas, electric, water), and fuel oil assistance. It also helps with medical care, emergent dental care, prescription medication and medical supply assistance, eye care, funeral expenses, prosthetic devices, home health aide and visiting Nurse Association homemaker services.
Contact:
Soldiers' Sailors' and Marines' Fund
864 Wethersfield Avenue
Hartford, CT 06114-3184
Tel: 860.296.0719
Toll-free (CT): 800.491.4941
Fax: 860.296.0820
Email: john.monahan@po.state.ct.us

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Recent News

The First Annual CRPS/RSD Awareness Quilt Bee in Indianapolis to raise awareness of veterans suffering from CRPS


More veterans struggle with pain syndrome

Disabled veteran challenges VA's rating system

Veteran to fight for benefits in DC on behalf of RSD sufferers

USAF Reservist Battles Injury and Government Insurance System

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Research Articles

Author: Cohen SP, Griffith S, Larkin TM, Villena F, Larkin R
Title: Presentation, Diagnoses, Mechanisms of Injury, and Treatment of Soldiers Injured in Operation Iraqi Freedom: An Epidemiological Study Conducted at Two Military Pain Management Centers
Source: Anesth Analg. 2005;101:1098-103.

Authors: Rosemary C. Polomano, PhD, RN, FAAN,Chester C. Buckenmaier III, MD,Kyung H. Kwon, MSN, CRNP, Alexandra L. Hanlon, PhD,Christine Rupprecht, MSN, RN,Cynthia Goldberg, MSN, RN-BC,and Rollin M. Gallagher, MD, MPH
Title: Effects of Low-Dose IV Ketamine on Peripheral and Central Pain from Major Limb Injuries Sustained in Combat
Source: Pain Medicine 2013; *: **_**Wiley Periodicals, Inc.

Author: Ruamwijitphong W
Title: Spinal cord stimulation for injured soldiers with complex regional pain syndrome
Source: The Nurse Practitioner. 2010;35(8):39-43.

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Clinical Trials

Regional Anesthesia Military Battlefield Pain Outcomes Study (RAMBPOS)
The purpose of this study is to examine the short and long-term benefits of implementing early advanced regional anesthesia techniques for pain control, such as reducing pain disability and the incidence and severity of mental health disorders, following major traumatic injuries to extremities encountered during combat in the Iraqi/Afghanistan war.

Click here to view more clinical trials currently recruiting

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Updated August 12, 2013

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