Sadly, the reality of specialising in claims involving chronic pain is that for a very small number of our clients suffering from Complex Regional Pain Syndrome (CRPS), their pain proves wholly resistant to treatment, and worse, can increase over time and even begin to spread.
For those who find themselves in that dreadful position, their thoughts often turn to the possibility of amputation. Understandably, amputation is controversial.
There is conflicting research on its efficacy as a method of long term pain relief for therapy resistant CRPS and the simple fact is that it is impossible to predict the outcome before the limb has been amputated.
Research published in 2014 (Bodde et al) noted that in addition to unbearable pain, factors influencing the decision to amputate include joint contractures, non-healing wounds or infection and a fear of sepsis.
In CRPS, the risk of phantom limb pain is very high, but the question of amputation in CRPS is further complicated as there remains the uncertainty of whether the amputation has been carried out above the level of the CRPS.
Anecdotally, many pain consultants seem to believe that in the case of severe CRPS, the risk of recurrence of the CRPS in the amputation stump is high; possibly as much as 50%.
However, although research has shown that many CRPS patients do badly in terms of the recurrence of pain, they were often relieved that the affected limb was gone and was not part of them anymore. Indeed, people considering amputation often say that they no longer consider the affected limb to be a part of them.
In terms of CRPS in the lower limb, the popularity now of disabled sport and the sight of amputee athletes running with blades often seems to give cautious hope to formerly fit and active people, now incapacitated by unbearable pain. However, the practical difficulty of the recurrence of pain for many amputees, upper or lower limb, is that the use of a prosthesis is not always possible as they simply cannot put it on.
In terms of personal injury claims where amputation is a possibility, with claims for the cost of future prosthetics alone often exceeding £300,000, claimants and their solicitors must be prepared to deal with an avalanche of hostility from the other party and their insurance company.
Ultimately, however, for most claimants who have exhausted all other treatment options and are faced with this terrible choice, we don’t believe they can be criticised should they decide to take their chance with amputation.
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