Diagnostic Conceptualization for CRPS-1: Challenges in the IASP's Diagnostic Conceptualization for CRPS-1 (Formerly Conceptualized as RSD)
Robert J. Barth
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Tom W. Bohr
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Abstract

Complex regional pain syndrome-type 1 (CRPS-1) is a problematic diagnosis of a characteristic burning pain that is present without stimulation or movement, occurs beyond the territory of a single peripheral nerve, and is disproportionate to the inciting event. This article highlights some challenging aspects of the diagnostic formulation for CRPS-1 by the International Association for the Study of Pain (IASP) and provides recommendations to address the issues. First, the terminology, CRPS-1, was created specifically to replace the previous term, “reflex sympathetic dystrophy.” Unfortunately, no gold standard diagnostic tests exist for CRPS-1, and the concept itself has a long and continuing history of controversy, not the least factor of which is the lack of reliable diagnostic schemes. Next, IASP's criteria for CRPS-1 do not standardize the diagnostic process and depart from epidemiologic guidelines, particularly regarding continuing pain, allodynia, or hyperalgesia disproportionate to any inciting event. Further, the IASP protocol overlaps diagnostic criteria for somatoform disorders, eg, those in the American Psychiatric Association's diagnostic manual, DSM-IV-TR. Finally, according to the IASP protocol, the majority of CRPS-1 patients present with symptoms that are indistinguishable from those in the DSM-IV-TR guidelines, and the majority of CRPS-1 cases are indistinguishable from the formal definition of malingering.

  • 1.

    Robert J. Barth, PhD, FNAN, Southeastern NeuroScience, P.C., Chattanooga, TN and Birmingham, AL. Tom W. Bohr, MD, FAAN, Associate Professor of Neurology, Loma Linda University School of Medicine. For correspondence or reprint request please contact: Dr. Robert J. Barth, 2337 McCallie Avenue, Plaza One Suite 300, Chattanooga, TN 37404. The authors would like to extend their gratitude to Brandi Mangan for her work on this project.

    • Search Google Scholar
    • Export Citation
  • 2.

    Harden RN, Baron R, Janig W, ed. Complex Regional Pain Syndrome. Seattle: International Association for the Study of Pain Press; 2001.

  • 3.

    Ensalada LH. Fifth Edition: Causalgia, RSD, CRPS impairment evaluation. The Guides Newsletter. July-August 2001:14.

  • 4.

    van de Beek WJ, Schwartzman RJ, van Nes SI. Diagnostic criteria used in studies of reflex sympathetic dystrophy. Neurology. 2002;58(4):5226.

    • Search Google Scholar
    • Export Citation
  • 5.

    Schott GD. Interrupting the sympathetic outflow in causalgia and reflex sympathetic dystrophy. A futile procedure for many patients. British Medical Journal. 1998;316:792793.

    • Search Google Scholar
    • Export Citation
  • 6.

    Butler S. Disuse and CRPS. In: Harden RN, Baron R, Janig W, ed. Complex Regional Pain Syndrome. Seattle: International Association for the Study of Pain Press; 2001:141150.

    • Search Google Scholar
    • Export Citation
  • 7.

    van de Vusse AC, Stomp-van den Berg SGM, de Vet HCW, Weber WEJ. Interob-server reliability of diagnosis in patients with complex regional pain syndrome. Eur J Pain. 2003;7:25965.

    • Search Google Scholar
    • Export Citation
  • 8.

    Cocchiarella L, Anderson G, ed. Guides to the Evaluation of Permanent Impairment Fifth Edition. Chicago: American Medical Association; 2001.

    • Search Google Scholar
    • Export Citation
  • 9.

    Bruehl S, Harden RN, Galer BS, et al. External validation of IASP diagnostic criteria for complex regional pain syndrome and proposed research diagnostic criteria. Pain. 1999;81:147154.

    • Search Google Scholar
    • Export Citation
  • 10.

    Ochoa JL, Verdugo RJ. Reflex sympathetic dystrophy: a common clinical avenue for somatoform expression. Neurologic Clinics. 1995;13:351363.

    • Search Google Scholar
    • Export Citation
  • 11.

    Verdugo RJ, Ochoa JL. Abnormal movements in complex regional pain syndrome: assessment of their nature. Muscle Nerve. 2000;23(2):198205.

    • Search Google Scholar
    • Export Citation
  • 12.

    Mersky H, Bogduk N, ed. Classification of Chronic Pain: Descriptons of Chronic Pain Syndromes and Definitions of Pain Terms, Second Edition. Seattle: International Association for the Study of Pain Press; 1994.

    • Search Google Scholar
    • Export Citation
  • 13.

    Allen G, et al. Epidemiology of complex regional pain syndrome. Pain. 1999;80:539544.

  • 14.

    Sackett DL, Haynes R, Guyatt G, Tugwell P. Clinical Epidemiology, A Basic Science for Clinical Medicine, Second Edition. Philadelphia: Lippincott, Williams, and Wilkins; 1991.

    • Search Google Scholar
    • Export Citation
  • 15.

    Stanton-Hicks M. Reflex sympathetic dystrophy: changing concepts and taxonomy. Pain. 1995;63,127133.

  • 16.

    Ochoa JL. Truths, errors, and lies around “reflex sympathetic dystrophy” and “complex regional pain syndrome”. J Neurol. 1999;246:875879.

    • Search Google Scholar
    • Export Citation
  • 17.

    American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders Text Revision. 4th ed. Washington DC; 2000.

  • 18.

    van de Vusse AC, Stomp-van den Berg S, and Weber WEJ. Discrepancy between complaints and objective signs in chronic regional pain syndrome: a multi-observer study. The Pain Clinic. 2002;13(3):245249.

    • Search Google Scholar
    • Export Citation
  • 19.

    Marchettini P, Lacerenza M, Formaglio F. Sympathetically maintained pain. Curr Rev Pain. 2000;4(2):99104.

  • 20.

    Pawl RP. Controversies surrounding reflex sympathetic dystrophy: a review article. Curr Rev Pain. 2000;4(4): 25967.

  • 21.

    van de Vusse AC, Stomp-van den Berg SGM, de Vet HCW, Weber WEJ. Clinical reliability of diagnosis in complex regional pain syndrome (CRPS). Neurology. 2000;53(suppl 3):A177178.

    • Search Google Scholar
    • Export Citation
  • 22.

    Harden RN, Bruehl S, et al. Prospective examination of pain-related and psychological predictors of CRPS-like phenomena following total knee arthroplasty: a preliminary study. Pain. 2003; 106:393400.

    • Search Google Scholar
    • Export Citation
  • 23.

    Yutzy SH. Somatoform Disorders. In: Hales RE, Yudofsky SC editors. The American Psychiatric Publishing Textbook of Clinical Psychiatry Fourth Edition. Washington, DC: American Psychiatric Publishing; 2003.

    • Search Google Scholar
    • Export Citation
  • 24.

    Monti DA, Herring CL, Schwartzman RJ, Marchese M. Personality assessment of patients with complex regional pain syndrome type I. The Clinical Journal of Pain. 1998;14:295302.

    • Search Google Scholar
    • Export Citation
  • 25.

    van de Vusse AC, Stomp-van den Berg SGM, de Vet HCW, Weber WEJ. Interob-server reliability of diagnosis in patients with complex regional pain syndrome. Eur J Pain. 2003;7:259265.

    • Search Google Scholar
    • Export Citation
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