The disease at the center of the $261M Johns Hopkins verdict

Complex regional pain syndrome, or CRPS, is a rare, difficult to diagnose condition at the center of the recent $261 million verdict against Johns Hopkins All Children's Hospital.

A jury on Nov. 9 ruled that the St. Petersburg, Fla.-based hospital must pay damages to the family of 17-year-old Maya Kowalski, who was confined to the hospital for months starting in 2016. Hospital staff had called a child abuse hotline when Maya's mother demanded ketamine to treat her daughter's CRPS, suspecting Munchausen syndrome by proxy. During the time in which Maya was confined to the hospital, her mother took her own life. The family filed suit in 2018 and the case was made famous by the Netflix documentary "Take Care of Maya." The hospital's defense team plans to appeal the verdict. 

CRPS is considered rare and is estimated to affect about 200,000 people in the U.S. every year. The neurological condition most often causes constant or intermittent pain in the limbs that can present as a burning or itching sensation and cause increased sensitivity to stimuli, such as a pinch. There are a range of other symptoms, including changes in skin temperature, color and texture, and decreased function in the affected body part, according to healthcare providers. 

The condition and its causes aren't fully understood, and there's no single test to diagnose it. In most cases, the condition develops after nerve trauma or injury to the affected limb. Experts believe symptoms are the result of damage to the thinnest sensory and autonomic nerve fibers. In some cases, CRPS develops without an obvious injury. 

CRPS can be acute or chronic, with treatments ranging from physical therapy to pain-reducing medications and acupuncture. Treatment is highly specific to individual patients, though a combination of different options is typically necessary, according to Mayo Clinic. In some cases, if CRPS does not respond well to a range of other therapies, providers may recommend more invasive treatments, such as low doses of intravenous ketamine. 

For some, the condition can be severely debilitating.

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