Search for other papers by Robert J. Barth in
Current site
Google Scholar
PubMed
Search for other papers by Tom W. Bohr in
Current site
Google Scholar
PubMed
Abstract
From the previous issue, this article continues a discussion of the potentially confusing aspects of the diagnostic formulation for complex regional pain syndrome type 1 (CRPS-1) proposed by the International Association for the Study of Pain (IASP), the relevance of these issues for a proposed future protocol, and recommendations for clinical practice. IASP is working to resolve the contradictions in its approach to CRPS-1 diagnosis, but it continues to include the following criterion: “[c]ontinuing pain, which is disproportionate to any inciting event.” This language only perpetuates existing issues with current definitions, specifically the overlap between the IASP criteria for CRPS-1 and somatoform disorders, overlap with the guidelines for malingering, and self-contradiction with respect to the suggestion of injury-relatedness. The authors propose to overcome the last of these by revising the criterion: “[c]omplaints of pain in the absence of any identifiable injury that could credibly account for the complaints.” Similarly, the overlap with somatoform disorders could be reworded: “The possibility of a somatoform disorder has been thoroughly assessed, with the results of that assessment failing to produce any consistencies with a somatoform scenario.” The overlap with malingering could be addressed in this manner: “The possibility of malingering has been thoroughly assessed, with the results of that assessment failing to produce any consistencies with a malingering scenario.” The article concludes with six recommendations, and a sidebar discusses rating impairment for CRPS-1 (with explicit instructions not to use the pain chapter for this purpose).
- Abstract
- I. Introduction
- II. Self-contradiction in Regard to Exclusion Criteria
- III. Indications That Such Challenges Will not Be Resolved in the Near Future
- IV. Options for Resolving These Challenges
- V. Summary and Recommendations
- V. A. Address the General Medical Portion of the Diagnostic Process as if the CRPS-1/RSD Concept Did not Exist.
- V. B. If the CRPS-1/RSD Diagnosis is Being Seriously Considered, the Lack of Correlation With Physical Injury Should Be Emphasized
- V. C. If the CRPS-1/RSD Diagnosis Is Being Seriously Considered, Then the Consistency With a Somato-form Disorder Should Be Emphasized
- V. D. If the CRPS-1/RSD Diagnosis Is Being Seriously Considered, Then the Consistency With the Guidelines for the Assessment of Malingering Should Be Emphasized as Well
- V. E. For all Cases of Claimed or Suspected CRPS, Clinicians Should Fully Utilize the Diagnostic Protocol That Is Detailed in Chapter 16 of the Guides Fifth Edition
- V. F. Future Definitions and Protocols for CRPS Should Emphasize the Importance of Objective Findings on Examination, Should Comply With Epidemiology Principles, Should Be Completely Free From any Overlap With Malingering, and Should Be Completely Free From any Overlap with Somatoform Disorders
- References
-
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 please contact: Robert J. Barth PhD, 2339 McCallie Avenue, Plaza One Suite 202, Chattanooga, TN 37404.
-
2.
Harden, RN, Bruehl, SP. Diagnostic criteria: the statistical derivation of the four criterion factors. In: Wilson PR, Stanton-Hicks M, Harden RN. CRPS: Current Diagnosis and Therapy. International Association for the Study of Pain, Seattle: 2005.
-
3.
Barth RJ, Bohr TW. Challenges in the IASP's diagnostic conceptualization for CRPS-1 (formerly conceptualized as RSD). The Guides Newsletter. January-February 2006:4–8, 12.
-
4.
Peterson DI. A study of 249 patients with litigated claims of injury. The Neurologist. 1998;4:131–137.
-
5.
Weintraub M. Litigation-chronic pain syndrome: a distinct entity. Analysis of 210 cases. Amer J Pain Management. 1992;2:198–204.
-
6.
Mailis A, Papagapiou M, Umana M, Cohodarevic T, Nowak J, Nicholson K. Unexplainable nondermatomal somatosensory deficits in patients with chronic nonmalignant pain in the context of litigation/compensation: a role for involvement of central factors? J Rheumatol. 2001;28:1385–93.
-
7.
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):A177–178.
-
8.
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)259–265.
-
9.
Cocchiarella L, Anderson G, eds. Guides to the Evaluation of Permanent Impairment 5th Edition. Chicago: American Medical Association; 2001.
-
10.
Marchettini P, Lacerenza M, Formaglio F. Sympathetically maintained pain. Curr Rev Pain. 2000;4(2):99–104.
-
11.
Forouzanfar T, Koke AJ, van Kleef M, et al. Treatment of complex regional pain syndrome type I. Eur J Pain. 2002;6(2): 105–22.
-
12.
Sandroni P, Benrud-Larson LM, McClel-land RL, et al. Complex regional pain syndrome type I: incidence and prevalence in Olmsted County, a population-based study. Pain. 2003;103(1-2): 199–207.
-
13.
van de Vusse AC, Stomp-van den Berg S, Weber WEJ. Discrepancy between complaints and objective signs in chronic regional pain syndrome: a multi-observer study. The Pain Clinic. 2002;13(3): 245–249.
| All Time | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 913 | 913 | 77 |
| Full Text Views | 23 | 23 | 0 |
| PDF Downloads | 0 | 0 | 0 |
