Challenges in the Diagnostic Conceptualization of CRPS-1 (Formerly Conceptualized as RSD)
Robert J. Barth
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Tom W. Bohr
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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).

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    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.

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