I haven't had your girlfriends experience, or close, but I would think there must be a distinct possibility that the IME has set up this pain increase....in which case it isn't a bad idea to get it documented as soon as possible. If she is in so much pain that you have to get her to the ER, then she needs some help anyway.

I'm so sorry, this condition is bad enough without all the hoops you have to jump through....and IMHO any extra physical exam should only be being done by a doc experienced in dealing with CRPS, not any old muppet. But the patient never gets a choice sadly.

My CRPS has spread, but in my experience the first sign of spread was an aching pain with some stabbing pains in the area, then the burning, etc and mounting pain. It definitely wasn't that fast for me, BUT this is not the same for everyone, and that doesn't mean your GF's experience ISN'T spread. It's so complex. I would say though that a dramatic pain increase that doesn't resolve quickly must be looked at immediately. It might not be 'just' the CRPS. The exam might have caused a muscle spasm, tendon injury, nerve injury....

I hope her pain subsides quickly and that whatever caused this pain spike isn't anything long-term. Let us know what happens, and tell her we are rooting for her and crossing our fingers.

Bram.