External validation of IASP diagnostic criteria for Complex Regional Pain Syndrome and proposed research diagnostic criteria

Stephen Bruehl*, Robert N Harden, 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

469 Scopus citations

Abstract

Recent work in our research consortium has raised internal validity concerns regarding the current IASP criteria for Complex Regional Pain Syndrome (CRPS), suggesting problems with inadequate sensitivity and specificity. The current study explored the external validity of these IASP criteria for CRPS. A standardized evaluation of signs and symptoms of CRPS was conducted by study physicians in 117 patients meeting IASP criteria for CRPS, and 43 patients experiencing neuropathic pain with established non-CRPS etiology (e.g. diabetic neuropathy, post-herpetic neuralgia). Multiple discriminant function analyses were used to test the ability of the IASP diagnostic criteria and decision rules, as well as proposed research modifications of these criteria, to discriminate between CRPS patients and those experiencing non-CRPS neuropathic pain. Current IASP criteria and decision rules (e.g. signs or symptoms of edema, or color changes or sweating changes satisfy criterion 3) discriminated significantly between groups (P<0.001). However, although sensitivity was quite high (0.98), specificity was poor (0.36), and a positive diagnosis of CRPS was likely to be correct in as few as 40% of cases. Empirically-based research modifications to the criteria, which are more comprehensive and require presence of signs and symptoms, were also tested. These modified criteria were also able to discriminate significantly, between the CRPS and non-CRPS groups (P<0.001). A decision rule, requiring at least two sign categories and four symptom categories to be positive optimized diagnostic efficiency, with a diagnosis of CRPS likely to be accurate in up to 84% of cases, and a diagnosis of non-CRPS neuropathic pain likely to be accurate in up to 88% of cases. These results indicate that the current IASP criteria for CRPS have inadequate specificity and are likely to lead to overdiagnosis. Proposed modifications to these criteria substantially improve their external validity and merit further evaluation. Copyright (C) 1999 International Association for the Study of Pain. Published by Elsevier Science B.V.

Original languageEnglish (US)
Pages (from-to)147-154
Number of pages8
JournalPain
Volume81
Issue number1-2
DOIs
StatePublished - May 1 1999

Keywords

  • Causalgia
  • Complex regional pain syndrome
  • Diagnosis
  • Diagnostic criteria
  • Reflex sympathetic dystrophy
  • Validation

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Anesthesiology and Pain Medicine

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