TY - JOUR
T1 - External validation of IASP diagnostic criteria for Complex Regional Pain Syndrome and proposed research diagnostic criteria
AU - Bruehl, Stephen
AU - Harden, Robert N
AU - Galer, Bradley S.
AU - Saltz, Samuel
AU - Bertram, Martin
AU - Backonja, Miroslav
AU - Gayles, Richard
AU - Rudin, Nathan
AU - Bhugra, Maninder K.
AU - Stanton-Hicks, Michael
PY - 1999/5/1
Y1 - 1999/5/1
N2 - 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.
AB - 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.
KW - Causalgia
KW - Complex regional pain syndrome
KW - Diagnosis
KW - Diagnostic criteria
KW - Reflex sympathetic dystrophy
KW - Validation
UR - http://www.scopus.com/inward/record.url?scp=0032954613&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0032954613&partnerID=8YFLogxK
U2 - 10.1016/S0304-3959(99)00011-1
DO - 10.1016/S0304-3959(99)00011-1
M3 - Article
C2 - 10353502
AN - SCOPUS:0032954613
SN - 0304-3959
VL - 81
SP - 147
EP - 154
JO - Pain
JF - Pain
IS - 1-2
ER -