A brief review of complex regional pain syndrome and current management

Figures & data

Table 1. Budapest criteria.

Procedure Standards*	I. All symptoms criteria should be asked at each formal evaluation II. For unilateral CRPS, assess asymmetry via comparison with the contralateral extremity III. For bilateral CRPS, assess for changes relative to an unaffected extremity or assess for asymmetry relative to a typical, healthy individual Iv. The full criteria must be applied to each individual extremity v. In the event an examiner observes a sign that the patient does not express as a symptom, a “signs over-rides symptoms” approach cannot automatically apply^#
The Budapest Criteria	For the clinical diagnosis of CRPS, all of the following must be true:
	I. Patient describes continuing pain, disproportionate to the inciting event
	II. Patient reports at least one symptom in all four categories 1. Sensory a. Allodynia b. Hyperalgesia 2. Vasomotor a. Temperature asymmetry b. Skin color changes c. Skin color asymmetry 3. Sudomotor a. Change in or asymmetrical edema b. Change in or asymmetrical sweating 4. Trophic a. Decreased range of motion b. Weakness, tremor, dystonia c. Changes of hair, nail, skin
	III. Physician observes at least one sign in at least two categories 1. Sensory a. Allodynia to light touch (light manual touch or brush*), temperature, somatic pressure (application of pressure until the examiner’s nail bed turns white, roughly 100g/cm^2*) or vibration (assessed with a graded tuning fork over a bony prominence*) b. Hyperalgesia to pinprick (applied centrally in most affected extremity and compared to the same location in the unaffected extremity*) 2. Vasomotor a. Temperature asymmetry of >1 °C (If quantitative metric is not obtainable, temperature change should be obvious to examiners when touching the area with the dorsum of their hands*) b. Skin color changes c. Skin color asymmetry 3. Sudomotor a. Change in or asymmetrical edema b. Change in or asymmetrical sweating 4. Trophic a. Decreased range of motion b. Weakness, tremor, dystonia c. Changes of hair, nail, skin
	IV. No other diagnosis better explains the described symptoms and observed signs
Corresponding Diagnosis	CRPS Type I	If the criteria are met at the time of evaluation and there is no known nerve lesion in the affected area
	CRPS Type II	If the criteria are met at the time of evaluation in an anatomic region extending beyond the territory of any identified nerve injury*
	CRPS with Remission of Some Features*	If the medical record confirms the criteria have been met at some historical point. However, the criteria are not met at the time of evaluation
	CRPS Not Otherwise Specified	If the medical record confirms the criteria have never been met.* However, there is no alternative diagnosis that better explains the presentation

Adapted from Harden et al.

^*Indicates taxonomic or procedural clarification described by Goebel et al.

^#See Goebel et al for examples of such situations and recommended action.

Data availability statement

Data sharing is not applicable to this article as no new data were created or analyzed in this study.