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CRPS...make the Diagnosis


In 2003, The Budapest Consensus Group modified the definition and set of clinical criteria for complex regional pain syndrome.
THE GENERAL DEFINITION OF THE SYNDROME:
Complex regional pain syndrome (CRPS) describes an array of painful conditions that are characterized by a continuing (spontaneous and/or evoked) regional pain that is seemingly disproportionate in time or degree to the usual course of any known trauma or other lesion.  The pain is regional (not in a specific nerve territory or dermatome) and usually has a distal predominance of abnormal sensory, motor, sudomotor, vasomotor and/or trophic findings.  The syndrome shows variable progression over time.
THE DIAGNOSTIC CRITERIA:
There are two versions of the proposed diagnostic criteria: a clinical version meant to maximize diagnostic sensitivity with adequate specificity, and a research version meant to more equally balance optimal sensitivity and specificity.
CLINICAL DIAGNOSTIC CRITERIA FOR CRPS:
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
*A sign is counted only if it is observed at time of diagnosis.
The research diagnostic criteria for CRPS differ from the clinical diagnostic criteria in one respect.  In the research criteria, the second requirement is written as follows: Must report at least one symptom in each of the four following categories: (the same four categories are listed in both sets of criteria).

Harden RN, Bruehl S, et al. [Guideline] Reflex Sympathetic Dystrophy Syndrome Association (RSDSA).  Complex Regional Pain Syndrome: Clinical Guidelines: Introduction and Diagnostic Considerations. June 2006. http://www.rsds.org/3/clinical_guidelines/TXguidelines_Intro_diagnostic.pdf - Accessed: July 2012
www.ninds.nih.gov/disorders/reflex_sympathetic_dystrophy/detail_reflex_sympathetic_dystrophy.htm  (national institute of neurological disorders and stroke – national institute of health) accessed July 23, 2012.


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