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  • Chronic Pain Syndrome

    Chronic Pain

    Complex regional pain syndrome (CRPS) is described by the National Institute of Chronic Disorders and Stroke as a chronic pain condition most often affecting one of the limbs (arms, legs, hands, or feet), usually after an injury or trauma to that limb. CRPS is believed to be caused by damage to, or malfunction of, the peripheral and central nervous systems.

    The central nervous system is composed of the brain and spinal cord, and the peripheral nervous system involves nerve signalling from the brain and spinal cord to the rest of the body. CRPS is characterized by prolonged or excessive pain and mild or dramatic changes in skin colour, temperature, and/or swelling in the affected area.

    A Legal Decision concerning CRPS

    In the High Court case of Smyth -v- C&M Construction Ltd &Behan Quarries Ltd [2014] IEHC 372 what seemed, at first, a fairly minor accident had consequences for the

    Regional Pain

    When pain is unbearable

    plaintiff that few could have foreseen at the time. He sustained a fracture dislocation of the radial head of his left elbow. Following immobilisation in a sling for three weeks, he had an open reduction internal fixation. His elbow was immobilised in a hinged brace for four months and he had extensive physiotherapy. Subsequently, he developed ulnar nerve compression. This resulted in further surgery in which he had ulnar nerve decompression and transposition of the nerve. He also developed left neck and left shoulder pain in his upper arm, radiating down to his hand and his little and ring fingers. He also developed numbness of his left hand. He had decreased power in his upper left limb with the result that he could drop things. His grip was unreliable. Medication was of little help. The plaintiff described his pain as excruciating.

    Interrupting the pain

    Spinal Cord Stimulator

    Dr. Keaveney, the pain specialist, diagnosed a CRPS. Having prescribed a course of injenctions which failed to alleviate symtoms, Mr. Keaveney decided upon treatment that he described in Court as the last resort in such cases. This treatment was the insertion into the patient’s body of a Spinal Cord Stimulator (SCS). It is done in an invasive surgical procedure which involves the placing of a battery under the surface of the skin at an abdominal location and the internal fixation of an electrical stimulator at the top of the spine. It requires hospital admission and anaesthesia for placement. So, also, do the two replacements that most people need in their lifetime.

    How was the Plaintiff compensated?

    Four Courts, Dublin

    High Court, Dublin

    The plaintiff`s accident occurred on the 6th October 2008. He was employed in the Construction Industry. While the plaintiff`s total Award was €526,695, his General Damages for his pain and suffering was only €150,000, the balance of the compensation being apportioned towards loss of earnings and other out-of-pocket expenses.

    How much is an injury worth?

    While this is a subject for another Article, there is no doubt that this plaintiff suffered greatly from his injury. It was accepted by both the plaintiff`s and the defendant`s Medical experts that the plaintiff was very genuine in his complaints. In the words of Mr Justice Hedigan the plaintiff presented “as a remarkably genial and resigned person. He struck me as a completely honest witness” and yet he was awarded what might appear to be a relatively small sum for what is genuinely horrific pain and suffering.

    This case is however probably more indicative of the current value of injuries of this nature. Solicitors often have difficulty in advising their clients of the value of their injuries and in particular convincing them that their case is not worth as much as the client believes or indeed as much as the client`s friends have told him it is worth!This case is a salutary lesson that compensation can never really “compensate “for pain or indeed put the plaintiff back in the position he was before the accident. It can only go some way towards that aspiration.