Materiały źródłowe

• #1 Diagnosis of complex regional pain syndrome

  https://www.e-acn.org/journal/view.php?number=618

  Complex regional pain syndrome (CRPS) is a chronic regional pain disorder that most frequently affects the limbs. […] There are no specific laboratory diagnostic tools for CRPS, and so it is diagnosed clinically. […] The Budapest criteria are currently the most-accepted diagnostic criteria. […] The definition of and diagnosis methods for CRPS have evolved over time. […] A diagnosis of CRPS is strongly and independently correlated with fibromyalgia, which increases the risk up to 2.5-fold compared with controls. […] There are no specific laboratory diagnostic tools for CRPS, and so it is diagnosed clinically. However, various diagnostic tools are frequently used to support the diagnosis of CRPS. […] Reflex sympathetic dystrophy was first identified using the Veldman criteria in 1993.

• #2 Complex Regional Pain Syndrome (CRPS): Causes & Symptoms

  https://my.clevelandclinic.org/health/diseases/12085-complex-regional-pain-syndrome-crps

  Complex regional pain syndrome (CRPS) is a condition that causes pain, changes in skin color and other symptoms in a certain part of your body usually in your extremities. […] The symptoms of CRPS can greatly impact the function of your affected limb, sleep, daily activities and your mental health. […] Since the symptoms of CRPS usually improve over time, its easiest for healthcare providers to diagnose it in the early stages. Its important to see a provider soon after you experience symptoms of CRPS. […] Since CRPS is rare and healthcare providers dont totally understand it, its often misdiagnosed. […] Theres no specific test to diagnose CRPS. Healthcare providers mainly diagnose it through a careful medical history, physical examination and review of your symptoms. […] They may order imaging tests, such as an ultrasound or magnetic resonance imaging (MRI), to look for underlying nerve damage. But its not always possible to find the nerve damage. […] Your provider may also order other tests to rule out conditions that cause similar symptoms. For example, electromyography (EMG) may reveal other causes of neuropathy, which may result in some similar pain scenarios.

• #3

  https://www.orthobullets.com/basic-science/6095/complex-regional-pain-syndrome-crps

  Complex Regional Pain Syndrome, also known as reflex sympathetic dystrophy, is an idiopathic condition caused by an aberrant inflammatory response that leads to sustained sympathetic activity in a perpetuated reflex arc. Patients present with extremity pain out of proportion to physical exam findings. […] Diagnosis is made clinically with the Budapest diagnostic criteria and can be confirmed by pain relief with sympathetic block. […] Diagnosis is usually clinical but can be confirmed by pain relief with sympathetic block. […] Early diagnosis is critical for a successful outcome. […] Budapest diagnostic criteria: 1. Continuing pain that is disproportionate to any inciting event. 2. Must report at least one symptom in three (clinical diagnostic criteria) or four (research diagnostic criteria) of the following categories: sensory: hyperesthesia or allodynia; vasomotor: temperature asymmetry, skin colour changes, or skin colour asymmetry; sudomotor/edema: edema, sweating changes, or sweating asymmetry; motor/trophic: decreased range of motion, motor dysfunction (weakness, tremor, or dystonia), or trophic changes (hair, nails, or skin). 3. Must display at least one sign at time of diagnosis in two or more of the following categories: sensory: hyperalgesia (to pinprick) or allodynia (to light touch, deep somatic pressure, or joint movement); vasomotor: temperature asymmetry, skin colour changes or asymmetry; sudomotor/edema: oedema, sweating changes, or sweating asymmetry; motor/trophic: decreased range of motion, or motor dysfunction (weakness, tremor, or dystonia), or trophic changes (hair, nails, or skin). 4. No other diagnosis better explains the signs and symptoms.

• #4 Complex Regional Pain Syndrome | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/0700/p49.html

  Complex regional pain syndrome (CRPS) is a rare, chronic pain disorder. The diagnosis is made clinically using standardized diagnostic criteria. […] CRPS is diagnosed clinically using the Budapest criteria. Adjunct testing should be used to evaluate for alternative diagnoses when clinically indicated. […] CRPS is diagnosed clinically, with no standard objective assessment for the diagnosis. The Budapest criteria developed by the International Association for the Study of Pain is 99% sensitive and 68% specific for CRPS, with increased sensitivity as other diagnoses are ruled out. […] Adjunct testing should be used to evaluate for alternative diagnoses when clinically indicated.

• #5 Criteria for diagnosis | Faculty of Pain Medicine

  https://www.fpm.ac.uk/documents/criteria-diagnosis

  A diagnosis of Complex Regional Pain Syndrome (CRPS) was made based on the Budapest Criteria. […] The International Association for the Study of Pain (ISAP) convened an international panel of experts to suggest an improved diagnostic criteria who met in Budapest, and the resultant proposal for modified diagnostic criteria for CRPS (the Budapest Criteria) was adopted by ISAP and remains the most clinically used criteria for CRPS diagnosis. […] To make the clinical diagnosis of CRPS, the following criteria must be met: […] 1. Continuing pain, which is disproportionate to any inciting event […] 2. Must report at least one symptom in three of the four following categories: […] 3. Must display at least one sign at time of evaluation in two or more of the following categories: […] 4. There is no other diagnosis that better explains the signs and symptoms.

• #6 Complex regional pain syndrome | Healthify

  https://healthify.nz/health-a-z/c/complex-regional-pain-syndrome

  The guidelines for diagnosing CRPS are called the Budapest Criteria. They state that all 4 of the following must be met for a clinical diagnosis to be made: Continuing pain which is disproportionate to any inciting event (more intense than would be expected after the event you experienced) […] At least 1 sign (based on evaluation or testing) in 2 or more of the categories […] At least 1 symptom (based on your experiences) in 3 or more of the categories […] No other diagnosis can better explain the signs and symptoms (eg, arthritis, infection, bone or soft tissue injury, peripheral nerve damage).

• #7

  https://journals.lww.com/pain/fulltext/2021/05000/screening_and_diagnostic_tools_for_complex.4.aspx

  Complex regional pain syndrome is highly complex and given the large number of potential signs and symptoms, it can be challenging to diagnose. There is no gold standard radiological, laboratory, genetic, or electrical diagnostic test for CRPS. Over time, several clinical tools specifying signs and symptoms have been developed; however, they vary in their description of the disease. Having clear diagnostic criteria would allow clinicians to identify the disease accurately and initiate appropriate treatments. A screening tool would further allow clinicians to expedite access to treatments and referrals to specialists. […] This systematic review identified 4 diagnostic tools validated for use in adults, none validated in pediatric populations, and no screening tools for any age group. The 4 diagnostic tools identified include the Veldman criteria, IASP criteria, Budapest Criteria, and Budapest Research Criteria.

• #7

  https://journals.lww.com/pain/fulltext/2021/05000/screening_and_diagnostic_tools_for_complex.4.aspx

  At present, clinicians should take caution when applying any diagnostic tool to children and adolescents with suspected CRPS. For clinicians in pediatric pain clinics, a clinical diagnosis based on expertise is most appropriate. […] Future research is needed to develop and/or validate a diagnostic tool for pediatric CRPS, and a screening tool for CRPS for both children and adults. A self-report screening tool for CRPS would help clinicians who may not have the requisite knowledge, skill, or judgement to use diagnostic criteria. Furthermore, a screening tool would aid in identifying patients on waitlists who need rapid assessment to confirm diagnosis. Ideally, a screening tool would have excellent sensitivity as opposed to a diagnostic tool where a more balanced profile of sensitivity and specificity is best suited.

• #8 Complex Regional Pain Syndromes Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/1145318-workup

  No specific diagnostic tests confirm the presence of CRPS. However, the differential diagnosis includes other neuropathic conditions as well as a host of metabolic, systemic, vascular, and rheumatologic disorders. Excluding other treatable but serious causes is indicated even in cases that present with the classic signs and symptoms. […] Blood work for inflammatory arthropathy and vasculitis is indicated, which, in its basic form, includes a complete blood count (CBC), erythrocyte sedimentation rate, C-reactive protein, antinuclear antibody, rheumatoid factor, complement fixation panel, serum immunoelectrophoresis, and a bone scan. Workup for diabetes should also include a test for hemoglobin A1c. […] Electromyography (EMG) and nerve conduction studies are helpful in determining the neuroanatomy behind the symptoms and therefore in identifying the etiologic process. For example, they confirm the presence of nerve injury, CRPS type II, nerve root avulsion, or a painful neuropathy due to diabetes, which may present with autonomic dysfunction.

• #9 Complex Regional Pain Syndromes Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/1145318-workup

  Vascular studies of the affected limb(s) should also be considered. […] Osseous changes are common in CRPS; therefore, most standard diagnostic test results used to support or refute clinical evidence for this diagnosis demonstrate changes, or a lack thereof, in the bones and joints. […] In the chronic stages of CRPS, plain radiographs may reveal endosteal and intracortical excavation, resorption of subperiosteal and trabecular bone, localized bone demineralization, and/or osteoporosis. […] Compared with radiography, three-phase bone scintigraphy has higher sensitivity (97% vs 73%) and specificity (86% vs 57%) in early postfracture CRPS. […] Three-phase bone scintigraphy can provide valuable information during the first year and is useful in differentiating CRPS from other pain syndromes.

• #10 Diagnostic Testing in Complex Regional Pain Syndrome | Neupsy Key

  https://neupsykey.com/diagnostic-testing-in-complex-regional-pain-syndrome/

  The diagnosis of complex regional pain syndrome is based on clinical criteria; however, several diagnostic tests may be useful in supporting the diagnosis. […] The diagnosis of complex regional pain syndrome (CRPS) is made, primarily, based on the previously mentioned clinical criteria. However, diagnostic testing can be utilized to support the diagnosis of CRPS and/or to rule out other diagnoses. […] The sensitivity and specificity for TPBS in the diagnosis of CRPS is low; studies have found that when CRPS is diagnosed using the Budapest Criteria, the sensitivity of TPBS is 40%55.1% and the specificity is 76.6%93.5%. Therefore, a negative TPBS does not exclude the diagnosis of CRPS. […] Note that skin temperature is dynamic; therefore, the presence of symmetric thermometric or thermographic findings does not exclude the diagnosis of CRPS.

• #11 Complex Regional Pain Syndrome | National Institute of Neurological Disorders and Stroke

  https://www.ninds.nih.gov/health-information/disorders/complex-regional-pain-syndrome

  No single test can confirm CRPS. Often a recent injury or surgery can give clues. Diagnosis should be considered early in a person with recent onset of limb pain, even if there is no known trauma, so that appropriate treatment can be started. It is important that a person with new CRPS be evaluated as soon as possible. […] The Budapest criteria for CRPS is a useful tool in diagnosing CRPS. It is based on symptoms and signs of abnormal pain sensation such as allodynia or hyperalgesia, temperature or skin color changes, changes in sweating or limb swelling, and decreased mobility or abnormal movement of the limb. […] Nerve conduction studies can detect most CRPS-2 associated nerve injuries, but would be normal in CRPS-1. […] Ultrasound or MRI (magnetic resonance imaging) can reveal underlying nerve and tissue damage. Bone and bone marrow abnormalities on MRI can help localize the CRPS affected limb. Ultrasound may reveal localized tissue damage. […] Triple-phase bone scans (using a radiotracer agent) sometimes show areas of bone changes that are affected by CRPS. The test can be useful in some cases in confirming the presence of CRPS in a limb.

• #12 Complex Regional Pain Syndromes Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/1145318-workup

  Bedside testing for allodynia and hyperalgesia is important to remove subjectivity from the sensory portion of the examination when confirming the diagnosis of CRPS. […] AFT includes infrared thermometry, infrared thermography, the quantitative sudomotor axon reflex test (QSART), the thermoregulatory sweat test (TST), and laser Doppler flowmetry. […] In a study of 21 patients with CRPS, enhanced sudomotor output was demonstrated with QSART and TST in the affected limb compared with the contralateral limb within the mean disease duration of 5 weeks. […] One hypothesis is that CRPS type I is caused by persistent minimal nerve injury, particularly distal degeneration of the small-diameter axons. […] Skeletal muscles in the affected extremities demonstrate (1) a decrease in type 1 fibers, (2) an increase in lipofuscin pigment, (3) atrophic fibers with a slight angular appearance, and (4) severely thickened basal membrane layers in the capillaries. […] In the affected extremities, efferent nerve fibers are unchanged histologically; with afferent fibers, only C fibers have demonstrated histopathologic abnormalities, which consist of denervation of the Schwann cell stacks, miniature axon sprouts, and an obvious increase in collagen pockets.

• #13 Complex regional pain syndrome: Types, symptoms, stages, and causes

  https://www.medicalnewstoday.com/articles/184338

  If a patient seeks medical help, and they may have CRPS, the doctor will ask about their medical history and will look for swollen joints and changes in skin temperature and appearance. […] The diagnosis is based on clinical findings that exclude other possible causes. […] A number of diagnostic tests can help eliminate other causes and confirm a diagnosis. […] Blood tests can help exclude infection or inflammation in the joints as a possible cause of symptoms. […] Scans, such as ultrasound, may be used to rule out a blood clot, known as deep vein thrombosis. […] Thermography measures skin temperature of specific parts of the body. High or low skin temperature in the affected area could indicate CRPS. […] Electrodiagnostic testing, or nerve conduction studies, involve attaching wires to the skin and measuring the electrical activity of nerves. Abnormal readings could indicate nerve damage, and possible type 2 CRPS. […] X-rays can detect mineral loss in the bones at later stages. […] An MRI scan, a blood test or a biopsy can rule out underlying problems with bones or tissue.

• #14 Complex Regional Pain Syndromes Differential Diagnoses

  https://emedicine.medscape.com/article/1145318-differential

  With regard to the CNS, these include the following: Brain – Stroke, neoplasm, encephalitis. […] With regard to radiculopathy, these include the following: Structural – For instance, due to structural impingement of a discal, osteophyte-, or tumor-related nature. […] With regard to plexopathy, these include the following: Infectious, Autoimmune/idiopathic, Tumor (primary or secondary neoplasm), especially Pancoast syndrome. […] With regard to focal neuropathy, these include the following: Diabetes, Inflammatory or infectious (Lyme), sarcoid, Posttraumatic, Entrapment – Such as carpal tunnel, cubital tunnel. […] With regard to multifocal neuropathy (mononeuritis multiplex), these include the following: Diabetes, Vasculitis, Infectious, Toxic. […] With regard to bilateral or diffuse neuropathy, these include the following: Diabetes, Alcohol, Nutritional, Guillain Barre syndrome or chronic inflammatory demyelinating polyradiculoneuropathy, Porphyria.

• #15 Complex Regional Pain Syndromes Differential Diagnoses

  https://emedicine.medscape.com/article/1145318-differential

  Other diagnostic considerations include the following: Movement disorders, Monomelic amyotrophy, Metabolic or systemic – Such as renal failure, amyloidosis, Autoimmune or rheumatological disorder, Infectious – For instance, viral, fungal, Lyme disease, Iatrogenic – Such as prescribed medication, Demyelinating – Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), paresis or sensory deficiency due to multiple sclerosis, Toxic exposure – For example, vinca alkaloids, heavy metals.

• #16 Complex regional pain syndrome – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/crps-complex-regional-pain-syndrome/symptoms-causes/syc-20371151

  Complex regional pain syndrome (CRPS) is a form of chronic pain that usually affects an arm or a leg. CRPS typically develops after an injury, a surgery, a stroke or a heart attack. Treatment is most effective when started early. In such cases, improvement and even remission are possible. […] If you experience constant, severe pain that affects a limb and makes touching or moving that limb seem intolerable, see your health care provider to determine the cause. It’s important to treat CRPS early. […] If CRPS isn’t diagnosed and treated early, the disease may progress to more-disabling signs and symptoms.

• #17 Complex Regional Pain Syndrome – UF Health

  https://ufhealth.org/conditions-and-treatments/complex-regional-pain-syndrome

  Complex regional pain syndrome (CRPS) may not have a cure, but at UF Health, our dedicated team of pain medicine specialists is committed to slowing the progression of the disease and alleviating your symptoms. […] There is no single test which can confirm CRPS, and so diagnosing it can be difficult. Additionally, many patients experience gradually improving symptoms over time, sometimes making it more difficult to diagnose as time goes on. […] A health care provider will make a careful review of a patients medical history and perform a physical examination. Other tests may include: […] Comprehensive testing will also help rule out whether a patient has a different condition with similar symptoms, such as arthritis or a muscle disease. […] Early diagnosis is always preferable. An early diagnosis allows for early and aggressive treatment of symptoms. If CRPS is diagnosed in the first stage, sometimes signs of the disease may disappear and normal movement is possible. […] If the condition is not diagnosed quickly, changes to the bone and muscle may get worse and may not be reversible.

• #18 Complex Regional Pain Syndrome Information & Treatment

  https://www.columbiadoctors.org/health-library/condition/complex-regional-pain-syndrome/

  Complex regional pain syndrome (CRPS) is not common, so diagnosis can be hard. […] There’s no one test to diagnose CRPS. Your doctor will ask about your symptoms and past health. You will also get a physical exam. The exam may include touching your skin or bending your joints in the area that hurts. […] More tests may be needed to rule out other possible causes of your pain and to make a correct diagnosis. […] CRPS can be hard to diagnose. Your doctor may suggest that you see a specialist. This may be a neurologist, a rheumatologist, or a pain specialist.

• #19 Complex Regional Pain Syndrome Part 1: Essentials of Assessment and Diagnosis | PM&R KnowledgeNow

  https://now.aapmr.org/complex-regional-pain-syndrome-part-1-essentials-of-assessment-and-diagnosis/

  The Budapest criteria has been reported to have sensitivity of 0.99 and specificity of 0.79. […] Specific diagnostic criteria for the pediatric population are currently in development. Diagnostic accuracy of the Budapest criteria in children is somewhat limited as 37% of pediatric CRPS patients do not qualify as having CRPS. […] At this time, no laboratory studies are used for the assessment of CRPS. […] Various imaging modalities have been used for CRPS and could potentially be used to help diagnosis and monitoring; however at this time there are no radiologic diagnostic criteria established and the diagnosis is primarily clinical. […] Early diagnosis and intervention in CRPS is associated with improved outcome and function.

• #20 Complex regional pain syndrome – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/594

  Complex regional pain syndrome (CRPS) is prolonged pain, disproportionate to the initiating event, most frequently following minor trauma and most commonly affecting the distal aspect of an extremity. […] Diagnosis is clinical. No specific tests are diagnostic; investigations may be useful to support the diagnosis or rule out alternative pathology. […] Key diagnostic factors include history of trauma, history of immobilization, female sex, chronic pain, limb pain with radiation, allodynia and hyperalgesia, body scheme changes, edema, trophic skin and nail changes, erythema or bluish appearance, local sweating changes or sweating asymmetry, and muscle weakness. […] 1st tests to order: no test required: diagnosis is clinical. […] Tests to consider include electromyogram, nerve conduction studies with surface electrodes, punch skin biopsy, radiograph of affected limb, bone scintigraphy with technetium 99m, dual-energy x-ray absorptiometry (DXA), quantitative CT scan, MRI, vascular studies, sympathetic nerve blocks, and intravenous regional or selective anesthetic blocks. […] Emerging tests include autonomic testing.

• #21 Complex regional pain syndrome. An early diagnosis improves outcomes | Pain Management Today

  https://painmanagement.medicinetoday.com.au/pmt/2022/july/feature-article/complex-regional-pain-syndrome-early-diagnosis-improves-outcomes

  Complex regional pain syndrome (CRPS) is poorly understood and is diagnosed clinically with knowledge of the Budapest criteria. […] Early diagnosis and management of patients with CRPS is crucial to successful recovery. […] CRPS is a clinical diagnosis that is made after a thorough history and examination of a patient. To make the formal diagnosis of CRPS, the patient needs to fulfil a number of signs and symptoms using the Budapest Criteria. […] A strong suspicion of CRPS-like features should warrant referral of the patient to a specialised pain team. […] Although investigations such as bone scans may suggest the presence of CRPS, they are not enough in themselves to make the diagnosis.

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