12th January 2022
Marcus Grant represented the Claimant who was left with enduring symptoms.
Long description A 47-year-old Teaching Assistant sustained soft tissue injury to her right sacroiliac joint in a workplace slipping accident. The soft tissue injury did not progress towards full resolution. Instead, she developed referred neuropathic pain down the right leg which had some intermittent features of CRPS.
Within a few days of the accident, the pain spread to her right upper limb; thereafter she presented with profound neuropathic pain in her right upper and lower limbs. In the early period, some of the treating clinicians diagnosed Type I CRPS without nerve injury. However, over time the visible symptoms of CRPS remitted such that the Budapest criteria were not satisfied. The pain persisted. She suffered a loss of function in the workplace and in her home lives; an adjustment disorder with a prolonged depressive reaction followed. She became profoundly disabled by her pain.
She presented with some prior psychological vulnerability. Roughly 20 years before the accident, she developed some right sided sciatica and coccygeal pain following childbirth which caused her some difficulties for a short period. Femoral neuralgia was diagnosed at the time, and she was noted to have depression.
There were intermittent references to medically unexplained pains, including abdominal and pelvic pains; on one occasion she presented with pain in her right hand with a subjective colour change to the skin. Her work record was good. She was a mother to 4 children and had worked full time throughout most of the previous 20 years.
Her case was that she sustained a traumatically-induced primary chronic pain condition, characterised by neuropathic pain in the right upper and lower limbs that, at times, satisfied the CRPS diagnostic criteria. To the extent that her condition could not be explained in purely organic terms, it was explicable by reference to a diagnosis of somatic symptom disorder with predominant pain.
The litigation was put back to see whether her symptoms would remit with bespoke one-on-one treatment with a chronic pain physiotherapist and a chronic pain psychotherapist. By the eve of the sixth anniversary of the accident, the prognosis was guarded.
On her case, she would never work again and required daily input from a support worker and single level accommodation.
The defendant’s response was to suggest that the onset of the chronic symptoms following the six-month anniversary of the accident was a coincidental manifestation of a pre-existing psychological vulnerability, probably a pre-existing somatoform pain disorder. The causal nexus between the slipping accident and the emergence of the chronic symptoms was doubtful. In the alternative her symptoms were maintained by the stress for litigation and would remit swiftly following the conclusion of the litigation.
The parties negotiated against that evidential stand-off. The case settled eight weeks before trial through negotiation, with both parties moving away from their best-case positions.