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Complex Regional Pain Syndrome Diagnostic Criteria 

Definition of CRPS:

"CRPS is a syndrome characterized by continuing (spontaneous and/or evoked) regional pain that is seemingly disproportionate in time or degree to the usual course of pain after trauma or other lesions. The pain is regional (not in a specific nerve territory or dermatome) and usually has a distal predominance of abnormal sensory, motor, sudomotor, vasomotor edema, and/or trophic findings. The syndrome shows variable progression over time."(1)

It was for some time called "Reflex Sympathetic Dystrophy" but this is usually no longer advocated due to the murky implications that come with "reflex", "sympathetic" and "dystrophy". However some choose to still use the name for CRPS that follow a traumatic injury (CRPS 1).

Budapest Criteria(2), established in 2007, remains as the diagnostic criteria of choice for health professionals worldwide. It is fairly straightforward:

 

Budapest Clinical Diagnostic Criteria for Complex Regional Pain Syndrome

1. Continuing pain, which is disproportionate to any inciting event

2. Must report at least one symptom in three of the four following categories:

• Sensory: reports of hyperesthesia and/or allodynia

• Vasomotor: reports of temperature asymmetry and/or skin color changes and/or skin color asymmetry

• Sudomotor/edema: reports of edema and/or sweating changes and/or sweating asymmetry

• Motor/trophic: reports of decreased range of motion and/or motor dysfunction (weakness, tremor, dystonia) and/or trophic changes (hair, nail, skin)

3. Must display at least one sign at time of evaluation in two or more of the following categories:

• Sensory: evidence of hyperalgesia (to pinprick) and/or allodynia (to light touch and/or deep somatic pressure and/or
joint movement)

• Vasomotor: evidence of temperature asymmetry and/or skin color changes and/or asymmetry

• Sudomotor/edema: evidence of edema and/or sweating changes and/or sweating asymmetry

• Motor/trophic: evidence of decreased range of motion and/or motor dysfunction (weakness, tremor, dystonia) and/or trophic changes (hair, nail, skin)

4. There is no other diagnosis that better explains the signs and symptoms

References

1. Binder, A. Baron, R. (2013). Complex Regional Pain Syndromes. In S. K. McMahon, M. Koltzenburg, I. Tracey, & D. Turk (Eds), Wall and Melzack's Textbook of Pain (6th ed., pp.961). Philadelphia: Elsevier Saunders.

2. Harden RN, Bruehl S, Perez RS, Birklein F, Marinus J, Maihofner C, et al. Validation of proposed diagnostic criteria (the "Budapest Criteria") for Complex Regional Pain Syndrome. Pain. 2010;150(2):268-74.

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