AMA Guides recklessly disregard RSD/CRPS


The American Medical Association (AMA) has been (and still is) under fire for what experts are calling a reckless assault on injured workers’ care, causing ongoing injury to injured workers by disseminating false and misleading information about the diagnosis of reflex sympathetic dystrophy (RSD) also referred to as complex regional pain syndrome (CRPS Type I).

AMA Guides recklessly disregard RSD/CRPS


In June 2012, we published an article entitled ” WorkCover state the AMA guide does not recognise chronic pain” outlining that [WorkCover states]the AMA guides does not recognise (rate) chronic pain and how does this impact injured workers who, for example suffer from really extremely painful, debilitating complex regional pain syndrome (CRPS), aka as Reflex Sympathetic Dystrophy (RSD).

Under the WorkCover legislation physical injuries must be assessed in accordance with The American Medical Association Guides For The Evaluation Of Permanent Impairment. And that, folks, is the real big problem!

Although these Guides are now in their sixth edition, the WorkCover legislation in Victoria for example requires the fourth edition to be used. They are just about 20 years old and they are banned in civilised countries such as Canada and the USA.

The Guides (4th ed) have even been modified by the legislation which basically removes the pain chapter – how SICK! Pain is NOT ratable! The Guides have therefore been the subject of significant criticism because they also provide relatively worthless impairment assessments for musculoskeletal injuries particularly spinal injuries.

The use of the AMA guide (4th Edition) is based on pseudo science and designed to do only one thing: to stop people — especially the most vulnerable  — from being fairly compensated.

For an overview on how the AMA Guides 4th edition rate “pain”, including CRPS/RSD, see our previous article: WorkCover state the AMA guide does not recognise chronic pain

In addition to the flawed AMA 4th Ed as used in Victoria, the states that use the AMA Guides 5th Edition, such as for example NSW, also inflict further insult to such painful injuries.

The (US) Chairman of the Scientific Advisory Committee of the International Research Foundation for RSD/CRPS filed a complaint which was disregarded by the AMA

In  2003, a member of the AMA and Chairman of the Scientific Advisory Committee of the International Research Foundation for RSD/CRPS (Dr. Anthony Kirkpatrick) filed a complaint with the AMA putting the AMA on notice that it was causing ongoing injury to patients by disseminating false and misleading information about the diagnosis of reflex sympathetic dystrophy (RSD) also referred to as complex regional pain syndrome (CRPS Type I).

Dr Kirkpatrick wrote: “The false assertions by the AMA are particularly egregious because RSD/CRPS is a syndrome that must be treated in a timely manner in order to avert exacerbation of symptoms leading to irreversible impairment and suffering. I have personally witnessed patients with RSD/CRPS lose hope and commit suicide following denial of authorization for care by insurance carriers.”

There are countless injured workers who suffer from this debilitating, chronic, neurological syndrome. The syndrome can start after minor trauma, such as one caused for example by a sprained finger, or following minor trauma. But it can also be triggered by surgery or repetitive vibration motion — such as the kind that comes from a jackhammer or weed-cutting tool. While the cause of the disorder remains largely unknown, experts believe it is the result of a malfunction or misfiring in the body’s sympathetic nervous system, the part of the nervous system that regulates involuntary reactions to stress. The injury heals but the pain continues.

As RSD progresses over time, especially without treatment, the syndrome tends to become more unresponsive to treatment. Hence, early diagnosis and treatment are imperative. RSD can remain localised to one region of the body indefinitely. In other cases, it spreads to large segments of the body spontaneously or by trauma leading to permanent deformities and widespread immobility of limbs. At an advanced stage of the illness, all patients develop significant psychiatric problems and narcotic dependency, and are left completely incapacitated. Some commit suicide.

The critical issue that was raised by Dr Kirkpatrick is contained in the AMA GUIDES TO THE EVALUATION OF PERMANENT IMPAIRMENT, 5th Edition (as is currently in use in NSW)

On page 496, the clinical guidelines state that there “must” be at least eight (8) concurrent, objective signs for RSD in order to make the diagnosis. The AMA clinical guidelines refer to objective diagnostic criteria such as changes in skin temperature, color, sweating, swelling, etc. Dr Kirkpatrick informed the AMA, “…nowhere in the scientific literature will you find such stringent criteria for the diagnosis of RSD/CRPS.” The latter has been corroborated by many renowned pain specialists.

However, despite numerous complaints and pleas for amendment of the AMA Guides,  the AMA believes that it is acceptable to publish stringent diagnostic criteria for RSD (in the 5th ed).

Diagnostic information published by the AMA must be unbiased, scientific, evidence-based, and peer-reviewed. Yet, when confronted with its error, the AMA refuses to set the record straight and stand accountable before the public.

The harm cause by the AMA Guides is devastating to countless injured workers

The harm caused by the AMA’s (5th ed) error has been devastating to injured workers with RSD.

An injured nurse was recently denied workcover insurance approval for treatment of her severe RSD of her right arm.  A favourite”IME” “occupational phsyician” (well paid) by the workcover insurance company used the AMA’s harsh, but incorrect, diagnostic criteria for RSD to deny approval for treatment and the injured nurse was even accused of “faking” her injuries!

According to the International Research Foundation for RSD/CRPS, Sarah’s battle with RSD began when she was hit with a softball. She says, “I went to therapy and it kind of made me feel like I was kinda crazy but, I knew I wasn’t, but I was like really suicidal.” Sarah’s mother is livid about the AMA’s conduct. “Sarah had only two objective findings to support the diagnosis of RSD. If we would have waited until all eight objective findings were found before reaching a diagnosis of RSD, as published by the AMA, we would have lost a very special young lady and that to me is unthinkable. The fact that these people with the AMA are willing to prolong pain and suffering for these children and parents is deplorable. If a parent was to withhold medical care from their child then they would be charged with a crime; where is the difference?”

Injured workers (and TAC victims) from all walks of life fall victim to this terrible health care nightmare created by the AMA, and adopted by our workcover legislation.

As stated on the International Research Foundation for RSD/CRPS, “The last thing patients need now is incorrect and seemingly bogus clinical guidelines published by the AMA that are so restrictive that they prevent the diagnosis and treatment of a potentially catastrophic and lethal illness”.severe-crps

This means that injured workers who develop this extremely painful and debilitating condition, from a minor injury (CRPS can develop from a very minor injury such as a needle stick or a sprain!)  basically get bugger all (if not zero) percentage impairment rating under the AMA 4th edition  and 5th edition guidelines.

They may never be able to work again and yet they will not ever qualify for even a meager “lump sum”, let alone a common law damages claim.

Related articles and further reading


One Response to “AMA Guides recklessly disregard RSD/CRPS”

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    Deadman walking March 15, 2014 at 4:03 pm