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Abstract
Complex regional pain syndrome (CRPS) is a controversial, ambiguous, unreliable, and unvalidated concept that, for these very reasons, has been justifiably ignored in the “AMA Guides Library” that includes the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), the AMA Guides Newsletter, and other publications in this suite. But because of the surge of CRPS-related medicolegal claims and the mission of the AMA Guides to assist those who adjudicate such claims, a discussion of CRPS is warranted, especially because of what some believe to be confusing recommendations regarding causation. In 1994, the International Association for the Study of Pain (IASP) introduced a newly invented concept, CRPS, to replace the concepts of reflex sympathetic dystrophy (replaced by CRPS I) and causalgia (replaced by CRPS II). An article in the November/December 1997 issue of The Guides Newsletter introduced CRPS and presciently recommended that evaluators avoid the IASP protocol in favor of extensive differential diagnosis based on objective findings. A series of articles in The Guides Newsletter in 2006 extensively discussed the shortcomings of CRPS. The AMA Guides, Sixth Edition, notes that the inherent lack of injury-relatedness for the nonvalidated concept of CRPS creates a dilemma for impairment evaluators. Focusing on impairment evaluation and not on injury-relatedness would greatly simplify use of the AMA Guides.
- Abstract
- 1994: The IASP Invents the Concept of CRPS
- 1997: CRPS Is Introduced Into the Guides Library
- 1999: The Guides Casebook Reiterates Several Key Points
- 2001: CRPS Is Directly Addressed in the Guides to the Evaluation of Permanent Impairment
- 2006: Expanded Discussion of Diagnosis and Impairment Evaluation
- 2007: Differential Diagnosis and Relative Probabilities
- 2008: Two Major Guides Library Texts Expand the Discussion of CRPS
- The Future: Additional Contributions That Can be Made to the Evolution of the Concept of CRPS
- Broader Implications for the Future of the Guides Library
- References
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1
Barth, RJ. Complex Regional Pain Syndrome (CRPS): Unratable through the Pain Chapter. The Guides Newsletter. July/August, 2006. American Medical Association.
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2
Ring D. A Review of Causation for Carpal Tunnel Syndrome; in, Melhorn JM and Barr JS (Course Directors). 11th Annual American Academy of Orthopaedic Surgeons Occupational Orthopaedics and Workers Compensation Course. November 6-8, 2009. Boston, MA.
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3
Ochoa JL. Neuropathic Pain and Iatrogenesis. Continuum, Volume 7, Number 2, April 2001, page 91-104. American Academy of Neurology.
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4
Rondinelli, RD et al (editors). Guides to the Evaluation of Permanent Impairment, Sixth Edition. 2008. American Medical Association.
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5
Verdugo, RJ, and Ochoa, JL (2000). Abnormal movements in complex regional pain syndrome: assessment of their nature. Muscle Nerve, 23 (2), 198-205.
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6
Allen, G. et al., Epidemiology of Complex regional pain syndrome. Pain, 80, 1999, 539-544.
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7
Merskey H, Bogduk N, editors. Classification of Chronic Pain, 2nd ed. Seattle: International Association for the Study of Pain Press; 1994.
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8
Harden RN, Bruehl S, Stanton-Hicks M, Wilson PR. Proposed new diagnostic criteria for complex regional pain syndrome. Pain Med. 2007 May-Jun;8(4):326-31.
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9
Barth, RJ, and Bohr, TW. Challenges in the IASP's Diagnostic Conceptualization for CRPS-1 (Formerly Conceptualized as RSD), Part 1. The Guides Newsletter. January/February, 2006. American Medical Association.
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10
Barth, RJ, and Bohr, TW. Challenges in the IASP's Diagnostic Conceptualization for CRPS-1 (Formerly Conceptualized as RSD), Part 2. The Guides Newsletter. March/April, 2006. American Medical Association.
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11
Ensalada LH. The Challenge of Evaluating RSD Impairment and Disability (Part 1). Guides Newsletter, November/December, 1997. Pages 3-5.
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12
Harden RN, & Bruehl. Diagnostic Criteria: The Statistical Derivation of the Four Criterion Factors; in Wilson PR, Stanton-Hicks M, Harden RN (Editors). CRPS: Current Diagnosis and Therapy. Seattle: International Association for the Study of Pain Press; 2005.
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13
Bruehl S, Harden RN, Galer BS, Saltz S, Bertram M, Backonja M, Gayles R, Rudin N, Bhugra MK, and Stanton-Hicks M. External validation of IASP diagnostic criteria for Complex Regional Pain Syndrome and proposed research diagnostic criteria. Pain 1999; 81:147-154.
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14
Pawl, RP. Controversies surrounding reflex sympathetic dystrophy: a review article. Curr Rev Pain (2000) 4(4):259-67.
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15
Harden RN, Breuhl S, Galer BS, et al. Complex regional pain syndrome: are the IASP diagnostic criteria valid and sufficiently comprehensive? Pain, 83 (1999), 211-219.
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16
American College of Occupational and Environmental Medicine. Chronic Pain (Revised 2008) Occupational Medicine Practice Guidelines, 2nd Edition. American College of Occupational and Environmental Medicine, 2008.
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17
Melhorn, JM, and Ackerman, WE. Guides to the Evaluation of Disease and Injury Causation. 2008. American Medical Association.
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18
Brigham CR. The Guides Casebook. American Medical Association, 1999.
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19
Cocchiarella L, and Andersson GBJ. Guides to the Evaluation of Permanent Impairment, Fifth Edition. American Medical Association, 2001.
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20
Rating Impairment for CRPS I. Guides Newsletter, March/April 2006, page 10. American Medical Association.
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21
Barth RJ and Haralson R. Differential Diagnosis for Complex Regional Pain Syndrome. The Guides Newsletter, September/October 2007. American Medical Association.
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22
Barth RJ. Differential Diagnosis of Complex Regional Pain Syndrome; in Melhorn JM and Shilds NN (Course Directors). 9th Annual American Academy of Orthopaedic Surgeons Occupational Orthopaedics and Workers Compensation Course. October 26-28, 2007. Las Vegas, NV.
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26
Wilson PR, Stanton-Hicks M, Harden RN (Editors). CRPS: Current Diagnosis and Therapy. Seattle: International Association for the Study of Pain Press; 2005.
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27
Barth RJ. Obstacles to Claiming Permanence and Injury-Relatedness for “Posttraumatic” Headache. The Guides Newsletter, May/June, 2009. American Medical Association.
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