General Guideline Principles for General Principles
of Treatment of Complex Regional Pain Syndrome
for workers compensation patients

The New York State workers compensation board has developed these guidelines to help physicians, podiatrists, and other healthcare professionals provide appropriate treatment for General Principles of Treatment of Complex Regional Pain Syndrome.

These Workers Compensation Board guidelines are intended to assist healthcare professionals in making decisions regarding the appropriate level of care for their patients with ankle and foot disorders.

The guidelines are not a substitute for clinical judgement or professional experience. The ultimate decision regarding care must be made by the patient in consultation with his or her healthcare provider.

General Principles of Treatment of Complex Regional Pain Syndrome

The main idea is that CRPS nearly invariably results from an interplay between some degree(s) of physical pathologies (current or past), pain beliefs, anguish responses, genetics, previous or concurrent psychiatric difficulties, socioenvironmental variables, and work-site challenges.

In most cases, it is improper and insufficient to treat patients by concentrating on one of these to an exclusion of others. Supporting those activities and therapies that would enhance overall function while keeping realistic about deadlines and broad variances in achieving a functional recovery are key components of managing people with CRPS chronic pain.

To manage the pain and reduce dysfunction, it is critical to describe the pertinent anatomy and potential pain origins (or lack thereof). pharmaceuticals and interventional procedures that are less effective than those with probabilities If there are no evidence-based treatments that show efficacy, their usage should be thoroughly questioned.

This is particularly true considering the substantial amount of literature. suggesting that this may be caused by the placebo effect, expectations bias, and attention bias a sizeable portion of the benefit associated with the use of multiple new modifications to interventions used to treat other illnesses.

Complex regional painful syndrome – NYS WCB MTG 36 The patient should begin working or performing modified work as soon as possible. function level. He or she should get assistance during this transition, be informed of the possibility of worsening symptoms, and be reassured that pain with CRPS does not indicate harm.

If it seems unlikely that anything will be able to be done to relieve the patient’s pain, they should be made aware of this fact. They should then be given advice that emphasizes that many people with similar conditions go to work every day, take care of their families, and lead normal (or nearly common) lives, and that this does not imply disability or hopelessness.

It has been demonstrated that the clinicians’ “fear-avoidance assumptions” about the connection between pain and patients’ capacity to resume employment influence how they provide care.

Particular clinical signs point to unrecognized clinical pathology that needs other skills to be properly addressed.

  • The initial treatment deviates from the usual trends.


  • Non-anatomic or strange or unusual descriptions of pain distribution.


  • Examples include pain that feels like it is coming from a glove or stocking, shock-like pain, and pain.


  • that is present, scorching agony, and pain that travels up and down the neck and back.


  • regardless of position, medication, or physical therapies, all the time.


  • Taking medications either makes the pain worse or does not reduce it as planned.


  • Proper aggressive physical therapy doesn’t seem to be enhancing function as expected.


  • Other body parts begin to be involved with complaints of pain or dysfunction. Example patient –


    • Stops talking about going back to work in reference to a “cure” rather than a precise timeline.


    • Is not helped by any or all interventions for rational therapy.


    • Feels more pain with time, or at the very least, the amount of discomfort does not reduce.


    • Refuses to talk about his or her family circumstances.


    • Claims that the illness or injury is to blame for all their issues.


    • Excessively lashes out at their employer, coworkers the provider, or insurance, and/or has a vindictive attitude or a desire to establish their illness.

      Shows little interest in the home therapy plan or even in function rehabilitation.


  • There seem to be signs of severe psychosocial dysfunction or concomitant psychiatry.

To confirm the absence of physiological pathology and to reassure the patient that increasing participation in routine activities won’t negatively impact their overall physical state, a judicious referral may be necessary. As there is a substantial risk of harm from getting an MRI or other diagnostic scan branded “abnormal” because of the presence of anatomic but clinically irrelevant findings.

This referral must go to a highly qualified practitioner whose practice patterns are congruent with evidence-based medicine. Even if there is nothing odd for that person’s age group, such labeling could further degrade function and exacerbate disability.

What our office can do if you have workers compensation injuries

We have the experience to help you with their workers compensation injuries. We understand what you are going through and will meet your medical needs and follow the guidelines set by the New York State Workers Compensation Board.

We understand the importance of your workers compensation cases. Let us help you navigate through the maze of dealing with the workers compensation insurance company and your employer.

We understand that this is a stressful time for you and your family. If you would like to schedule an appointment, please contact us so we will do everything we can to make it as easy on you as possible.


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