Complex regional pain syndrome: Are the IASP diagnostic criteria valid and sufficiently comprehensive?

R. Norman Harden*, Stephen Bruehl, Bradley S. Galer, Samuel Saltz, Martin Bertram, Miroslav Backonja, Richard Gayles, Nathan Rudin, Maninder K. Bhugra, Michael Stanton-Hicks

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

282 Scopus citations

Abstract

This is a multisite study examining the internal validity and comprehensiveness of the International Association for the Study of Pain (IASP) diagnostic criteria for Complex Regional Pain Syndrome (CRPS). A standardized sign/symptom checklist was used in patient evaluations to obtain data on CRPS-related signs and symptoms in a series of 123 patients meeting IASP criteria for CRPS. Principal components factor analysis (PCA) was used to detect statistical groupings of signs/symptoms (factors). CRPS signs and symptoms grouped together statistically in a manner somewhat different than in current IASP/CRPS criteria. As in current criteria, a separate pain/sensation criterion was supported. However, unlike in current criteria, PCA indicated that vasomotor symptoms form a factor distinct from a sudomotor/edema factor. Changes in range of motion, motor dysfunction, and trophic changes, which are not included in the IASP criteria, formed a distinct fourth factor. Scores on the pain/sensation factor correlated positively with pain duration (P<0.001), but there was a negative correlation between the sudomotor/edema factor scores and pain duration (P<0.05). The motor/trophic factor predicted positive responses to sympathetic block (P<0.05). These results suggest that the internal validity of the IASP/CRPS criteria could be improved by separating vasomotor signs/symptoms (e.g. temperature and skin color asymmetry) from those reflecting sudomotor dysfunction (e.g. sweating changes) and edema. Results also indicate motor and trophic changes may be an important and distinct component of CRPS which is not currently incorporated in the IASP criteria. An experimental revision of CRPS diagnostic criteria for research purposes is proposed. Implications for diagnostic sensitivity and specificity are discussed. Copyright (C) 1999 International Association for the Study of Pain. Published by Elsevier Science B.V.

Original languageEnglish (US)
Pages (from-to)211-219
Number of pages9
JournalPain
Volume83
Issue number2
DOIs
StatePublished - Nov 1 1999

Keywords

  • Causalgia
  • Complex regional pain syndrome (CRPS)
  • Diagnosis
  • Reflex sympathetic dystrophy
  • Validity

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Anesthesiology and Pain Medicine

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