CRPS (complex regional pain syndrome) or RSD (reflex sympathetic dystrophy are over-diagnosed 71%-80% of the time, according to two research groups from Johns Hopkins Hospital. This means 71% to 80% of patients told they have CRPS or RSD do not have it. For an expense of $170,000, to properly diagnose and treat one hundred (100) CRPS (complex regional pain syndrome) or RSD (reflex sympathetic dystrophy, using the on-line tests from www.MarlyandClinicalDiagnostics.com, an insurance carrier or reinsurer, or self insured company and the associated TPA, can expect to save $64,000,000. This is not a typo…an expense of $170,000 will result in savings of $64,000,000. The attached proposed pilot research project will prove this.

1. Pain Validity Test and Diagnostic Paradigm and Treatment Algorithm:
Proposal for a Pilot with Any Reinsurance Company, Self-insured Company, or TPA to save
$64,000,000 on a $170,000 investment
www.MarylandClinicalDiagnostics.com Contact DocNelse@aol.com
Introduction:
Maryland Clinical Diagnostics (MCD) has reference articles from staff members of Johns Hopkins
Hospital, which show that 40% to 67% of chronic pain patients are misdiagnosed, i.e. diagnoses are
missed (1,2). Additional articles show that certain diagnoses are overused, i.e. a patient is told that they
have a disease, which they do not have. One example of this overuse and misuse of a diagnosis is
Complex Regional Pain Syndrome (CRPS) or, as it used to be called, Reflex Sympathetic Dystrophy (RSD).
One article published by a professor from Johns Hopkins Hospital shows that 80% of patients told they
have CRPS (RSD) actually have just nerve entrapments and other disorders (3). Another research article
from a Johns Hopkins Hospital doctor found that 71% of patients diagnosed with CRPS (RSD) really had
just nerve entrapment syndromes (4). Based on these finding, the proposed pilot for MCD testing to give
significant cost savings to TPAs working with any reinsurance company or self insurance company
working with a TPA, is shown below.
1) The company would identify five (5) of their major workers compensation TPAs, who insure at
least 100,000 lives, and ask each to assemble 30 of their active RSD (CRPS) cases.
2) The TPAs would send MCD a list of their typical reserves per case for the following diagnoses:
a) Reflex Sympathetic Dystrophy (RSD) or Complex Regional Pain Syndrome (CRPS)
b) Peripheral nerve entrapment
c) Thoracic outlet syndrome
d) Carpel tunnel syndrome
e) Ulnar nerve entrapment
f) Radial nerve entrapment
g) Sural nerve entrapment
h) Saphenous Nerve entrapment
i) Tibial nerve entrapment
j) Common or superficial or deep peroneal nerve entrapment
k) C4-5 or C5-6 radiculopathy

2. l) L4-5 or L5-S1 radiculopathy
3) The TPAs would then administer the $800 Diagnostic Paradigm and Treatment Algorithm, and
the $300 Pain Validity Test to these cases diagnosed as RSD (CRPS) by the treating doctor.
Administration would be done by the TPAs own independent medical examiners, or by nurse
case managers. Patients listed as “exaggerating pain patients” or “subjective pain patients” by
the Pain Validity Test will be excluded from the study. It is anticipated that 15% of the original
150 patients, or 22 patients will be eliminated from the study.
4) In all case , which qualify as an “objective pain patients” on the Pain Validity Test, and which are
currently listed as RSD (CRPS) on the insurance records, which receive the Diagnostic Paradigm
and Treatment Algorithm. If the diagnosis generated by the Diagnostic Paradigm was just nerve
entrapment alone, or in combination with some other diagnoses, (other than RSD (CRPS)), the
reserve for nerve entrapment syndromes, or other diagnoses, which excluded RSD (CRPS) would
be listed, and subtracted from the reserve which the insurance company normally has for RSD
(CRPS). This difference would be considered the potential cost savings. As an example, if the
reserve for an RSD case is typically $1,000,000, but the Diagnostic Paradigm shows a diagnosis of
just tibial nerve entrapment, which carries the reserve of $50,000, then $1,000,000-$50,000 or
$950,000 would be the potential cost savings on the case.
5) In cases where RSD (CRPS) and no other diagnoses, appeared, these would be considered RSD
(CRPS) cases, and no cost savings would be realized. In cases where RSD (CRPS) was a diagnosis
along with any other diagnoses, including nerve entrapment, these cases would be considered
as an RSD case. (ask for a proforma for calculating projected cost savings- email
Docnelse@aol.com).
6) Maryland Clinical Diagnostics will charge $6,000 a day, plus travel expenses, for training of all
insurance adjusters at a TPA,or physicians’ offices which would administer the tests, at each of
the 5 participating companies offices, so the adjustors and physicians’ staff would know how to
order the Diagnostic Paradigm, through a through the insurance carrier’s own independent
medical examiners, or by nurse case managers, and how to retrieve the results.
7) Researchers from Maryland Clinical Diagnostics would analyze the data for each of the insurance
carriers, so that there is no further demand on the resource of the insurance carrier. This is done
electronically, based on the data transmitted to Maryland Clinical Diagnostics, Inc. by the
claimant who takes the tests. The cost would be $30,000.
8) Maryland Clinical Diagnostics, Inc. (MCD) reserves the right to publish this data, but will give the
insurance carrier or TPA the option to participate in the publication or have their name
protected, at their option. Maryland Clinical Diagnostics, Inc. (MCD) will allow the insurance
carrier access to their own data, via electronic transmission.
All expenses for training personnel, travel, communication, research, and test administration will be
borne by the insurance carriers and payment would be made prior to the initiation of the project.

3. Budget for entire project. TOTAL COSTS
Cost of $300 Pain Validity Test X 100 $30,000
Cost of $800 Diagnostic Paradigm X 100 $80,000
Travel, training for test administration at 5 TPAs $30,000
Cost for compiling data, and publishing research $30,000
Total Cost to participate in project $ 170,000
Projected cost savings using the Diagnostic Paradigm $64,000,000
So for a $170,000 expense, the projected reduction in reserves would be $64,000,000
REFERRENCES:
1) Hendler,N.,Kozikowski,J.:" Overlooked Physical Diagnoses in Chronic Pain Patients Involved in
Litigation." Psychosomatics.Vol.34,No.6:494-501, November/December, 1993.
2) Hendler, N., Bergson, C., Morrison, C.: "Overlooked Physical Diagnoses in Chronic Pain Patients
Involved in Litigation, Part 2." Psychosomatics. Vol. 37, No.6: 509-517, November/December, 1996.
3) Dellon, AL, Andonian, E, Rosson, GD, CRPS of the Upper and Lower Extremity: Surgical Treatment
Outcome , J. Brachial Plex. Perihperal Nerve Inj. Feb. 20:4:1, 2009
4) Hendler, N.: “Differential Diagnosis of Complex Regional Pain Syndrome.” Pan Arab Journal of
Neurosurgery. Oct., pp. 1-9. 2002.