Budapest Criteria Research Articles

More than just a broken limb: Unmasking CRPS in Pakistan

Madam, Complex Regional Pain Syndrome (CRPS) is a debilitating pain disorder, usually affecting one limb, and occurring after a trauma. It is marked by intense pain out of proportion to the severity of the initial injury. Because CRPS is a rare condition, its pathophysiology, diagnosis, and treatment are not completely understood. The pathophysiology might involve an interplay between inflammation, genetics, nervous system changes, and psychological influences1. Despite the challenges in diagnosis, the currently accepted diagnostic criteria is the Budapest Criteria, established after revising the previous IASP Criteria which led to overdiagnosis.2 Once CRPS is identified, therapy can be just as complicated. The UK Royal College of Physicians outlines a multidisciplinary approach based on each patient’s individual needs.3 This involves patient education, utilizing intervention and medications for the pain, physical rehabilitation, and psychological intervention. Each of these elements is equally important for recovery. Older studies indicate a significant delay in CRPS diagnosis, with patients waiting an average of 4 years.4 The lack of knowledge among physicians, unnecessary surgeries, and the belief that patients might be exaggerating about their pain, all contribute to a delayed diagnosis. This leads to a further decline in limb function, muscle wasting, difficulty in performing everyday activities, and eventually, social isolation. To improve the understanding of CRPS in low-resource settings with limited patient data, Lewis et al. presented a global series from 9 different countries, including Pakistan.5 Despite being the world’s 5th most populous country, Pakistan lacks sufficient CRPS prevalence and presentation data. Out of the identified patients, only 16% were diagnosed according to the globally recognized Budapest criteria, and for 65% of patients, only pharmacological intervention was used. The essential multidisciplinary approach was rarely used. This highlights several issues that need to be resolved. This letter calls for localized research to help refine management protocols tailored to the Pakistani population. By raising awareness about the clinical features of CRPS and the consequences of neglect towards patients, we can promote timely diagnoses and avoid long-term complications. Physicians need to build trust with their patients and make them feel heard. CRPS is a complicated condition, so a culture of strict adherence to standardized diagnostic and management approaches must be created. Integration of said protocols into the healthcare curriculum is also essential. This comprehensive approach requires immediate implementation to improve quality of life and reduce unnecessary suffering.

Complex Regional Pain Syndrome, an Important Differential Diagnosis in Sports Injuries: a Case Report

Background: Complex regional pain syndrome (CRPS) is a disproportionate and persistent, regional pain related to a minor trauma. Although CRPS is not an infrequent condition its pathophysiology remains unknown and leading to underdiagnosis or late diagnosis. The diagnosis is clinical, according to Budapest criteria of the International Association for the Study of Pain. Bone scintigram is the most effective test to support the diagnosis. The aim of this article is to discuss the importance of clinical suspicion for an early CRPS diagnosis in a sprain’s young athlete clinical case. The Case: We present the case of a sixteen-year-old male patient with no medical history who suffered two minor ankle injuries in the right foot. The patient developed severe and persistent pain associated with vasomotor, sudomotor and trophic abnormalities. He remained undiagnosed for 10 months until CRPS diagnosis confirmation supported by a bone scintigram. He received multiple treatments until spontaneous remission in the fourth year of evolution. Discussion: CRPS poses a diagnostic challenge that requires early suspicion to improve treatment outcomes and prognosis. Maintaining a high index of clinical suspicion is crucial, and CRPS should be considered in the evaluation of any persistent pain sport-related injury. Despite extensive research on CRPS conducted in recent decades, this condition may still be unfamiliar to many healthcare providers. Increasing awareness of CRPS among medical professionals can facilitate timely and accurate diagnosis, which is essential for effective management.

Complex Regional Pain Syndrome: Diagnosis, Pathophysiology, and Treatment Approaches.

Complex regional pain syndrome (CRPS) is a chronic pain condition characterized by significant sensory, motor, and autonomic dysfunction, often following trauma or nerve injury. Historically known as causalgia and reflex sympathetic dystrophy, CRPS manifests as severe, disproportionate pain, often accompanied by hyperalgesia, allodynia, trophic changes, and motor impairments. Classified into type I (without nerve injury) and type II (associated with nerve damage), CRPS exhibits a complex pathophysiology involving peripheral and central sensitization, neurogenic inflammation, maladaptive brain plasticity, and potential autoimmune and psychological influences. The diagnosis relies primarily on clinical evaluation using criteria such as the Budapest Criteria, supported by supplementary tests to exclude differential diagnoses. However, its overlapping features with other conditions complicate diagnostic accuracy. The management of CRPS necessitates a multidisciplinary approach combining physical therapy, psychological support, and pharmacotherapy. Physical therapies, including graded motor imagery and mirror therapy, are essential for preserving function and preventing complications. Pharmacological treatments target neuropathic pain and inflammatory components, utilizing agents such as gabapentinoids, corticosteroids, and bisphosphonates. In refractory cases, interventional modalities like spinal cord stimulation and dorsal root ganglia stimulation provide promising options, although their efficacy remains variable. Emerging therapies, such as immune-modulatory treatments and advanced neuromodulation techniques, reflect the ongoing pursuit of effective interventions. This review synthesizes current knowledge, providing insights into diagnostic frameworks, pathophysiological mechanisms, and evolving treatment strategies to improve outcomes for individuals affected by CRPS.

Electronic Detection and Diagnosis of Complex Regional Pain Syndrome

Complex Regional Pain Syndrome (CRPS) is a chronic disease that is random and abrupt. As a result, an accurate diagnosis and treatment have yet to be identified due to numerous symptoms and causes. Currently, the method of diagnosis of CRPS is the Budapest Criteria. However, this criterion relies on the patient and doctor’s subjective judgments. Therefore, we propose to develop a diagnostic method for CRPS, integrating reliable and objective analysis of common patterns that occur in patients’ genetic and neuronal structures. Utilizing a zinc oxide biosensor, it was shown the patients’ blood samples with high concentrations of MMP-9, and neuroinflammation occurs as the immune system is impaired. By analyzing blood samples, we quantified the number of CD4+ T cells that penetrate nerves, with direct human CD4+ T cell counting. We compared the structure of neuron cells and identified damage in CRPS patients that were located primarily on dendrites. The significance of using DNA detection and neuron biochips will dramatically improve the diagnosis and treatment of CRPS.

Efficacy of N-acetylcysteine in reducing inflammation and oxidative stress to prevent complex regional pain syndrome type 1.

This study aimed to evaluate the effectiveness of N-acetylcysteine (NAC) in preventing complex regional pain syndrome type 1 (CRPS-1) by reducing proinflammatory cytokines and oxidative stress markers in patients with distal radius fractures. A retrospective single-center study at Bursa City Hospital involves patients over 50 years of age with distal radius fractures treated between January 2021 and December 2023. A total of 60 patients (mean age, 62.8 ± 5.1 years; 26 males and 34 females) were analyzed. Patients were divided into 2 groups: the NAC group (31 patients receiving 600-mg NAC daily for 3 months) and the control group (29 patients with no prophylactic medication). CRPS-1 diagnosis was based on Budapest criteria during multiple follow-up visits. Serum levels of interleukin (IL)-1 beta, IL-6, tumor necrosis factor-alpha (TNF-α), total oxidant status (TOS), and total antioxidant status (TAS) were measured at baseline and study end point. CRPS-1 positive patients had significantly higher levels of IL-6, TNF-α, and IL-1 (P < .001 for all), higher TOS (P < .001) and oxidative stress index (P < .001), and lower TAS (P < .001) compared with CRPS-1 negatives. The incidence of CRPS-1 was significantly lower in the NAC group (9.7%) compared with the control group (31.0%; P = .039). Logistic regression indicated a 78% reduction in CRPS-1 odds ratio with NAC treatment (odds ratio, 0.219 [95% confidence interval, 0.053-0.895]; P = .0322). NAC significantly reduced end-point levels and changes in IL-6 (P < .001), TNF-α (P < .001), and IL-1 (P = .038) and improved oxidative stress markers, showing higher TAS (P < .001), lower TOS (P < .001), and oxidative stress index (P < .001) compared with controls. NAC significantly reduced the risk of developing CRPS-1 by decreasing levels of proinflammatory cytokines and oxidative stress. This study highlights NAC's potential as a preventive treatment for CRPS-1 and emphasizes the importance of early intervention.

Efficacy and safety of neridronate in paediatric type I complex regional pain syndrome: a multicentre experience.

Evidence regarding the efficacy of neridronate in the treatment of complex regional pain syndrome type I (CRPS I) is increasing, however, very little data are available in paediatric age. Our aim was to analyse the safety and the efficacy of neridronate in a case series of children with CRPS I, according to the Budapest criteria, who did not respond to previous pharmacological and physical therapy. We collected data of children affected by CRPS I from three paediatric rheumatology centres who received neridronate. Efficacy was evaluated by changes in pain intensity, vasomotor changes, physical function, need for pain medications and MRI findings. Adverse effects were also documented. Five children (3 females and 2 males, mean age 10.4 years, range 7-13 years) who received neridronate (4 intravenous, 1 intramuscular) were included. All patients had failed previous medical treatments (NSAIDs in 4, local steroids in 2, gabapentin, vitamin D and calcium supplementation in 1) and non-medical therapies (physiotherapy in 4, magnetotherapy in 2, laser in 1). Four out of five patients reported a significant improvement in pain (average VAS pre-treatment 9.6, post-treatment 2.6), recovery of physical function, and a reduced need for pain medications. Before treatment, all patients underwent MRI which revealed bone oedema that disappeared in the three of them after treatment. Neridronate was well-tolerated as only one patient experienced mild flu-like symptoms. Our data suggest that in children as in adults with CRPS I, neridronate may represent an effective and safe treatment option, particularly in those who do not respond to other pain treatments.

Chronic regional pain syndrome following calcaneal fractures: what causes it and how may Vitamin C aid?

The purpose of the current study is to determine which variables influence the onset of chronic regional pain syndrome (CRPS) following Sanders type 1 calcaneal fractures, which are treated conservatively, and to discover how Vitamin C (VC) supplementation, which is often mentioned in the literature, affects the outcomes of these fractures. The study incorporated individuals who had a Sanders type 1 fracture that was both closed and non-displaced and were treated with conventional plaster. The current study retrospectively reviewed medical records to gather demographic data, duration of immobilization, smoking habits, administration of VC supplementation, and presence of diabetes mellitus (DM). The Budapest criteria were employed to make the clinical diagnosis of CRPS. The study cohort comprised 258 (75.9%) males and 82 (24.1%) females aged between 18 and 90 years who had sustained Sanders type 1 calcaneal fractures and were managed non-operatively. CRPS was detected in 42 (12.4%) of the 340 subjects. CRPS patients had a statistically higher immobilization duration than those without CRPS (p<0.05). Smoking and DM were more common among patients with CRPS (p<0.05) and CRPS patients had a much lower rate of VC consumption (4.8%) (p<0.05). The current study is the first to examine risk variables for CRPS after calcaneal fractures. Long periods of immobility, female gender, and lack of VC supplementation increase the risk of CRPS. CRPS also increases with diabetes and smoking.

Pediatric complex regional pain syndrome following maxillofacial trauma: A case report

Complex regional pain syndrome (CRPS) has been described as a painful disorder with a different type of presentation and evolution months after the noxious event. The affected area shows color and vasomotor changes. Diagnosis of CRPS is hard and usually made by the Budapest criteria, as the pathological basis is still not completely known. We present this rare case that supports the idea of managing signs and symptoms with a multidisciplinary approach and supports the effective presence of a subtype of CRPS in children. This could make any other physician aware of possible diagnosis and, in the future, support the possible integration of this subtype in the Budapest criteria.

Complex regional pain syndrome after distal radius fracture: A survey of current practices.

Complex regional pain syndrome (CRPS) is a common complication following distal radius fractures that is difficult to diagnose and can lead to permanent disability. While various proposed prophylaxis and treatment modalities exist, high-quality evidence guiding practice is limited. This survey of Orthopaedic Trauma Association (OTA) and Canadian Orthopaedic Association (COA) members was conducted with the primary aim of assessing practice patterns in distal radius fractures complicated with CRPS. An electronic survey was distributed to practicing orthopaedic surgeons in the COA and OTA. Questions assessed practice setting, preference in management of distal radius fractures and CRPS, comfort level in managing CRPS, and identification of gaps in management. Responses were anonymized and collected over 8 months. Response data was analyzed using descriptive statistics; thematic analysis was used on free text response. 134 survey responses were completed. 84% of respondents felt the incidence of CRPS in distal radius fractures was 1-10%, while 15% felt it was closer to 11-20%. 24% of respondents utilized the "Budapest Criteria" to diagnose CRPS. 40% offered prophylaxis in patients felt to be at high risk of developing CRPS. 66% of surgeons felt neutral, uncomfortable, or very uncomfortable managing CRPS in distal radius fractures. When asked to consider adopting a prophylactic therapy, 38% of surgeons indicated that a therapy that reduced the absolute risk of CRPS by 6-10% would change their practice. Gaps in current practice included lack of evidence-based treatment and prevention strategies and diagnostic uncertainty. This study identified that amongst orthopaedic surgeons in the COA and OTA, diagnosis, treatment, and prophylaxis strategies for CRPS in distal radius fractures are heterogeneous. Surgeons are not confident in their treatment of CRPS. Future studies using rigorous research methods are warranted to improve management.

Case Report: Complex Regional Pain Syndrome Involving the Head and Face After Severe Malignant Otitis Media and Mastoiditis

Background Complex regional pain syndrome (CRPS) is a rare condition characterized by intense chronic pain, vascular changes, swelling, and trophic changes leading to significant morbidity. It is often related to crush/mechanical injury or surgery and most commonly affects the limbs. There have only been a few rare documented cases affecting the head and face, and more scarce are CRPS cases of the head and face unrelated to trauma. Case We report a 79-year-old woman referred to Neurology after three months of severe, persistent left-sided head and face pain associated with discrete episodic swelling and localized autonomic symptoms, skin and hair changes in the affected area, following severe otitis media complicated by mastoiditis. Her history and neurologic exam did not meet a categorical diagnosis based on criteria in The International Classification of Headache Disorders-3rd edition and International Classification of Orofacial Pain, 1st edition but her symptoms and signs met the Budapest Criteria (BC) for a diagnosis of CRPS of the head and face. The patient had been on carbamazepine with only marginal benefit. After the initial Neurology evaluation, she started duloxetine and was referred for mirror visual feedback therapy. During an acute attack, she had a very good response to a sphenopalatine ganglion block and compounded intranasal and topical lidocaine-ketamine preparations were adjunctively added. Eleven months after initial symptom onset, she reported significant symptomatic improvement with markedly decreased disability and return to her premorbid quality of life. Conclusion Complex regional pain syndrome is difficult to recognize, there are no diagnostic tests, there is no definitive cure and management is symptomatic. Early identification and treatment may prevent significant morbidity and we recommend review and classification of such cases using the BC.

Impact of different CRPS phenotypes and diagnostic criteria on quantitative sensory testing outcomes: systematic review and meta-analysis.

This review and meta-analysis evaluated the impact of diagnostic criteria and clinical phenotypes on quantitative sensory testing (QST) outcomes in patients with complex regional pain syndrome (CRPS). Eight databases were searched based on a previously published protocol. Forty studies comparing QST outcomes between CRPS-I vs II, warm vs cold CRPS, upper vs lower limb CRPS, males vs females, or using Budapest vs older IASP criteria were included. Studies investigating QST differences between CRPS-I vs II (n = 4), between males vs females (n = 2), and between upper and lower limb CRPS (n = 2) showed no significant differences. Four studies compared QST outcomes in warm vs cold CRPS, showing heat hyperalgesia in warm CRPS, with thermal and mechanical sensory loss in cold CRPS. Although CRPS diagnosed using the Budapest criteria (24 studies) vs 1994 IASP criteria (13 studies) showed similar sensory profiles, there was significant heterogeneity and low quality of evidence in the latter. Based on the findings of this review, classifying CRPS according to presence or absence of nerve lesion into CRPS-I and II, location (upper or lower limb) or according to sex might not be clinically relevant as all appear to have comparable sensory profiles that might suggest similar underlying mechanisms. In contrast, warm vs cold phenotypes exhibited clear differences in their associated QST sensory profiles. To the extent that differences in underlying mechanisms might lead to differential treatment responsiveness, it appears unlikely that CRPS-I vs II, CRPS location, or patient sex would prove useful in guiding clinical management.

Sensibilidad de la respuesta simpática cutánea y de la gammagrafía en el diagnóstico del síndrome dolor regional complejo

ObjectiveTo evaluate the sensitivity of sympathetic skin response (SSR) and compare it with scintigraphy in patients with complex regional pain syndrome diagnosed according to the Budapest criteria. Material and methodsTwenty-two patients with complex regional pain syndrome who attended the Rehabilitation and Physical Medicine Department between January-2018 and May-2022 have been prospectively evaluated. The scintigraphy was considered positive if in the 1st-2nd phase slight asymmetric and diffuse uptake was observed, or when in the 3rd phase marked periarticular radioisotope uptake was observed. SSR was abnormal if: a) no response after 20 stimuli; b) lack of habituation with permanence of the stimuli greater than 67.2%. ResultsAge 55.4±8.57 years. Complex regional pain syndrome was more frequent in women (90.9%), more common in upper limbs (68.2%) than lower limbs (31.8%). In SSR, we have observed normal response (<67.2%) in 2 patients (11.1%), lack of SSR in 2 patients (11.1%) and lack of habituation (>67.2%) in 14 patients (77.8%). In total, 16 patients presented abnormal or absent responses (88.8%). The diagnostic sensitivity of scintigraphy is similar to that of SSR (89.5% vs 88.8%), with no statistical difference (P=.6721). ConclusionScintigraphy has shown similar sensitivity to SSR, although the simplicity, security, low cost, non-ionizing and non-invasiveness of the latter technique suggest that it could be more cost-effective. The lack of habituation and the absence of response could identify response patterns and localize the involvement in the afferent, central, efferent or post-ganglionic pathways.

Safety and Effectiveness of Stellate Ganglion Cryoablation in Complex Regional Pain Syndrome

This was a retrospective, observational, descriptive study to evaluate the safety and 6-month effectiveness of percutaneous cryoablation of the stellate ganglion for the treatment of complex regional pain syndrome (CRPS). Eight patients with CRPS diagnosed by Budapest criteria were treated with this procedure. CRPS symptom severity was assessed prior to the procedure and at 3-month intervals after the procedure using a novel CRPS scoring system—the Budapest score—created by the authors. The mean Budapest score prior to and 6 months (187 days, SD ± 43) after stellate ganglion cryoablation was 7.0 (SD ± 2.0) (n = 6) and 3.8 (SD ± 2.3) (n = 6), respectively, showing a decrease of 3.2 (SD ± 1.7) (n = 6; P = .006). There were no major adverse events due to the procedure, and there was only 1 minor adverse event. Stellate ganglion cryoablation is a feasible, safe, and minimally invasive procedure that may represent an efficacious adjunct treatment option for select patients with CRPS.

Conventional Radio-frequency Ablation in Laminectomy- and Discectomy-induced Complex Regional Pain Syndrome

Abstract Complex regional pain syndrome (CRPS) following lumbar spine surgery is a rare and underdiagnosed clinical entity. This case report discusses CRPS of the left lower limb following lumbar spine laminectomy and discectomy done for left lumbar radiculopathy secondary to disc herniation. CRPS was diagnosed by the exclusion of other possible diagnoses. The Budapest Criteria were applied for a definitive diagnosis. We treated the patient with conventional radio-frequency ablation of the sympathetic ganglion at L2 and L4 after a successful diagnostic block. He had significant relief in pain for the next 6 months.

Complex Regional Pain Syndrome (CRPS) - State of the Art in Diagnostics and Therapy

The complex regional pain syndrome (CRPS) usually occurs within a few weeks in 2-5% of all patients after trauma or surgery or subsequent measures of the distal extremities. There are certain risk factors for its occurrence but no "CRPS personality", instead there are factors that negatively influence the course. The prognosis is generally good ("rule of thirds"), but remaining limitations are common. The diagnosis is clinically possible according to the "Budapest criteria". Additional examinations are possible in case of doubt but are neither conclusive nor exclusive. Corticoids and bisphosphonates are used alongside drugs that have an effect on neuropathic pain. Invasive therapies do not have good evidence and have therefore lost their importance. The rehabilitative therapy is carried out actively and with a lot of self-exercises at an early stage. Invasive anesthetic, passive therapies are obsolete. Special forms of treatment are "graded exposure" (GEXP) in the case of dominant anxiety and, e.g., "graded motor imagery" (GMI) in case of neglect-like symptoms. In addition to educational and behavioral therapy elements, psychotherapy for CRPS also includes participation as part of graded exposure.

ID: 217192 CRPS Successfully Managed With Peripheral Nerve Stimulation: A Case Report

Complex Regional Pain Syndrome (CRPS) is characterized by prolonged and greater than expected pain, typically following a traumatic injury. [1] CRPS is commonly diagnosed using the Budapest criteria; however, there is no universally accepted treatment regimen available to patients with the condition. [2] The treatment of CRPS requires a multicomponent approach, including patient education, behavioral modification, physical therapy, medical therapy, and potentially interventional procedures.

Usefulness of thermography in the diagnosis and classification of complex regional pain syndrome

IntroductionWe propose a protocol for study of complex regional pain syndrome (CRPS) based on a battery of quantitative measures (skin thermography, electrochemical skin conductance and sensory thresholds) and apply such protocol to 5 representative cases of CRPS. Patients and methods5 CPRS cases (2 women/3 men) that met the Budapest criteria for the diagnosis of CRPS. ResultsAll patients showed spontaneous pain and allodynia. Two cases correspond to a stage I, in both the resting basal temperature was increased in the affected limb. Three cases reflect more advanced stages with a decrease in resting temperature and a delay in the recovery of the temperature when compared to contralateral limb. DiscussionThese non-invasive quantitative functional tests not only improve the diagnostic accuracy of CRPS but also, they help us to stratify and understand the pathological processes of the disease.

Subcutaneous Platelet Rich Plasma Therapy for Management of Hyperalgesia in Complex Regional Pain Syndrome

Objectives: Complex regional pain syndrome (CRPS), which usually develops after a traumatic event, often has a debilitating effect on the quality of life. Treatment is multidisciplinary and is based primarily on pain relief. Due to the symptoms of hyperalgesia and allodynia in patients with CRPS, dermatology opinion is often seeked. CRPS is a difficult disorder to treat and platelet-rich plasma (PRP) is a potential treatment modality for pain relief in this debilitating illness. We aimed to investigate the role of subcutaneous PRP for relief of hyperalgesia in patients with CRPS. Materials and Methods: A comparative prospective study of 15 male patients with CRPS diagnosed clinically by the Budapest criteria and radiologically by magnetic resonance imaging was enrolled for the study. PRP was injected subcutaneously at biweekly interval for 8 weeks and the results were assessed clinically by neuropathic pain score (NPS) score. The patient satisfaction was noted at baseline, 4 weeks, and 8 weeks. Patients were followed up for 3 months to assess the increase or decrease in hyperalgesia after stopping PRP. ANOVA was used with the Bonferroni correction for NPS score at various time interval. P ≤ 0.05 is considered statistically significant. Results: Numeric Rating Scale score showed statistically significant improvement at end of the study as compared to the baseline. Patients also had improvement in range of motion which was assessed at every visit. A few patients had mild redness and burning postprocedure which resolved spontaneously after a few hours. Conclusions: From this study, we concluded that subcutaneous PRP shows a significant reduction of hyperalgesia associated with CRPS.

Clinical results of lumbar sympathetic blocks in lower limb complex regional pain syndrome using infrared thermography as a support tool.

To describe the clinical outcomes for a group of complex regional pain syndrome patients using infrared thermography as an intraprocedural support tool when undertaking fluoroscopy-guided lumbar sympathetic blocks. 27 patients with lower limb complex regional pain syndrome accompanied by severe pain and persistent functional impairment. A series of three fluoroscopic-guided lumbar sympathetic blocks with local anesthetic and corticoids using infrared thermography as an intraprocedural support tool were performed. Clinical variables were collected at baseline, prior to each block, and one, three, and six months after blocks in a standardized checklist assessing each of the clinical categories of complex regional pain syndrome stipulated in the Budapest criteria. 23.75% of the blocks required more than one chance to achieve the desired thermal pattern and therefore to be considered as successful. A decrease in pain measured on a visual analogic scale was observed at all time points compared to pre-blockade data, but only 37% of the cases were categorized as responders, representing a ≥ 30% decrease in VAS, with the disappearance of pain at rest. An improvement of most of the clinical variables recorded was observed, such as tingling, edema, perception of thermal asymmetry, difference in coloring and sweating. There was a significant decrease of neuropathic pain and improvement of functional limitation. Logistic regression analysis showed the main variable to explain the probability of being a responder was immobilization time (odds ratio of 0.89). A series of fluoroscopy-guided lumbar sympathetic blocks controlled by infrared thermography in the treatment of lower limb CRPS showed a responder rate of 37%.

Signs and symptoms of pediatric complex regional pain syndrome - type 1: A retrospective cohort study

ABSTRACT Background Complex regional pain syndrome (CRPS) presents with an array of symptoms that can vary from child to child, making it difficult to diagnose and differentiate from other pain conditions such as chronic musculoskeletal (MSK) pain. Thirteen symptoms and signs are outlined in the Budapest criteria for CRPS (developed and validated for adults) but have not been well described in pediatrics. Aims The aim of this study was to describe the signs and symptoms of pediatric CRPS type 1 (CRPS 1) and determine whether a cluster of symptoms can differentiate CRPS 1 from chronic MSK pain. Methods A retrospective cohort study of pediatric patients with CRPS 1 and MSK pain in a pediatric pain program was conducted. Descriptive statistics were used to report demographics and pain characteristics. The chi-square test was used to evaluate differences in signs and symptoms between patients with CRPS and MSK pain. A logistic regression model was used to evaluate whether a cluster of symptoms could predict a diagnosis of CRPS 1. Results The sample included 187 patients (99 with CRPS 1 and 88 with MSK pain); 81% were female with a mean age 14.1 years. The most prevalent CRPS symptoms were hyperalgesia (54%) and allodynia (52%). A cluster of symptoms (hyperalgesia, color changes, and range of motion) predicted the probability of a diagnosis of CRPS 1. Conclusions A cluster of symptoms may be critical in differentiating pediatric CRPS 1 and MSK pain. Future research is needed to determine if this model is valid in external populations and to explore whether a similar model can differentiate CRPS 1 from other pain conditions (e.g., neuropathic pain).