Journal ArticleDOI
Complex regional pain syndrome: are there distinct subtypes and sequential stages of the syndrome?
Stephen Bruehl,R. Norman Harden,Bradley S. Galer,Samuel Saltz,Miroslav Backonja,Michael Stanton-Hicks +5 more
TLDR
Overall, these results are consistent with limited previous work that argues against three sequential stages of CRPS, but several distinct CRPS subtypes are suggested, and these could ultimately have utility in targeting treatment more effectively.Abstract:
This study tested for evidence supporting the clinical lore of three sequential stages of complex regional pain syndrome (CRPS) and examined the characteristics of possible CRPS subtypes. A series of 113 patients meeting IASP criteria for CRPS underwent standardized history and physical examinations to assess CRPS signs and symptoms in four domains identified in previous research: pain/sensory abnormalities, vasomotor dysfunction, edema/sudomotor dysfunction, and motor/trophic changes. K-Means cluster analysis was used to derive three relatively homogeneous CRPS patient subgroups based on similarity of sign/symptom patterns in these domains. The resulting CRPS subgroups did not differ significantly regarding pain duration as might be expected in a sequential staging model. However, the derived subgroups were statistically-distinct, and suggested three possible CRPS subtypes: (1) a relatively limited syndrome with vasomotor signs predominating, (2) a relatively limited syndrome with neuropathic pain/sensory abnormalities predominating, and (3) a florid CRPS syndrome similar to "classic RSD" descriptions. Subtype 3 showed the highest levels of motor/trophic signs and possible disuse-related changes (osteopenia) on bone scan, despite having directionally the briefest pain duration of the three groups. EMG/NCV testing suggests that Subtype 2 may reflect CRPS-Type 2 (causalgia). Overall, these results are consistent with limited previous work that argues against three sequential stages of CRPS. However, several distinct CRPS subtypes are suggested, and these could ultimately have utility in targeting treatment more effectively.read more
Citations
More filters
Journal ArticleDOI
Validation of proposed diagnostic criteria (the "budapest Criteria") for Complex Regional Pain Syndrome
Robert N Harden,Stephen Bruehl,Roberto S.G.M. Perez,Roberto S.G.M. Perez,Frank Birklein,Johan Marinus,Christian Maihöfner,Timothy R. Lubenow,Asokumar Buvanendran,Sean Mackey,Joseph R. Graciosa,Mila Mogilevski,Christopher E. Ramsden,Melissa Chont,Jean Jacques Vatine +14 more
TL;DR: This validation study compared current IASP diagnostic criteria for CRPS to proposed new diagnostic criteria (the “Budapest Criteria”) regarding diagnostic accuracy and suggested that inclusion of four distinct CRPS components in the Budapest Criteria contributed to enhanced specificity.
Journal ArticleDOI
The incidence of complex regional pain syndrome: a population-based study.
M. de Mos,A.G.J. de Bruijn,Frank J P M Huygen,Jeanne P. Dieleman,B.H.Ch. Stricker,Miriam C. J. M. Sturkenboom +5 more
TL;DR: The observed incidence rate of CRPS is more as four times higher than the incidence rate observed in the only other population‐based study, performed in Olmsted County, USA.
Journal ArticleDOI
Complex regional pain syndrome type I: incidence and prevalence in Olmsted county, a population-based study
TL;DR: CRPS I is of low prevalence, more commonly affects women than men, the upper more than the lower extremity, and three out of four cases undergo resolution, suggesting that invasive treatment of CRPS may not be warranted in the majority of cases.
Journal ArticleDOI
Complex regional pain syndrome: mystery explained?
Wilfrid Jänig,Ralf Baron +1 more
TL;DR: It is hypothesised that CRPS is a systemic disease involving the CNS and peripheral nervous system and there should be diagnostic reclassification and redefinition of CRPS.
Journal ArticleDOI
Complex regional pain syndrome: practical diagnostic and treatment guidelines, 4th edition.
R. Norman Harden,R. Norman Harden,Ann Louise Oaklander,Allen W. Burton,Roberto S.G.M. Perez,Kathryn Richardson,Melanie Swan,Jennifer Barthel,Brienne Costa,Joseph R. Graciosa,Stephen Bruehl +10 more
TL;DR: The fourth edition of diagnostic and treatment guidelines for complex regional pain syndrome (CRPS; aka reflex sympathetic dystrophy) is presented in this paper, where expert practitioners in each discipline traditionally utilized in the treatment of CRPS systematically reviewed the available and relevant literature; due to the paucity of levels 1 and 2 studies, less rigorous, preliminary research reports were included.
References
More filters
Book
Classification of Chronic Pain: Descriptions of Chronic Pain Syndromes and Definitions of Pain Terms
Journal ArticleDOI
Classification of Chronic Pain—Descriptions of Chronic Pain Syndromes and Definitions of Pain Terms
Journal ArticleDOI
Signs and symptoms of reflex sympathetic dystrophy: prospective study of 829 patients.
TL;DR: Early symptoms of reflex sympathetic dystrophy are those of an inflammatory reaction and not of a disturbance of the sympathetic nervous system, and support the concept of an exaggerated regional inflammatory response to injury or operation in reflex sympathetic Dystrophy.
Journal ArticleDOI
Peripheral nerve injury triggers central sprouting of myelinated afferents
TL;DR: It is shown that after peripheral nerve injury the central terminals of axotomized myelinated afferents, including the large Aβ fibres, sprout into lamina II, a structural reorganization in the adult central nervous system that may contribute to the development of the pain mediated by A-fibres that can follow nerve lesions in humans.
Journal ArticleDOI
Reflex sympathetic dystrophy: changing concepts and taxonomy
TL;DR: A revised taxonomic system for disorders previously called reflex sympathetic dystrophy (RSD) and causalgia is presented and these revised categories have been included in the 2nd edition of the IASP Classification of Chronic Pain Syndromes.