Terminology, criteria, and definitions in complex regional pain syndrome: challenges and solutions

Figures & data

Table 1 Selected nomenclature used for complex regional pain syndrome⁶

Causalgia	Algodystrophy
Sudeck’s atrophy
Reflex (sympathetic) dystrophy syndrome	Post-traumatic osteoporosis
Shoulder hand syndrome
Transient osteoporosis	Regional migratory osteoporosis

Note: Copyright ©1998. Littlejohn GO. Algodystrophy (reflex sympathetic dystrophy syndrome). In: Maddison PJ, Isenberg DA, Woo P, Glass DN, editors. Oxford Textbook of Rheumatology. Vol 2. Oxford: Oxford University Press; 1998:1679–1689.6 Reproduced by permission of Oxford University Press www.oup.com.

Table 2 “Budapest” clinical diagnostic criteria for complex regional pain syndrome²²

Each of the following criteria must be met:

1. Patients must report continuing pain that is disproportionate in time or degree to the usual course of pain after any trauma or other inciting event.

2. Patients must report at least one symptom in three of the four following categories:

a. sensory: hyperalgesia, (that is, exaggerated pain to a painful stimulus, such as pinprick) and/or allodynia (that is, pain elicited by a normally non-painful stimulus, such as light touch).

b. Vasomotor: skin color changes and/or skin color asymmetry and/or temperature asymmetry.

c. Sudomotor/edema: edema and/or sweating changes and/sweating asymmetry.

d. Motor/trophic: decreased range of motion and/or motor dysfunction (weakness, tremor, dystonia) and/or trophic changes/asymmetry involving nails, skin, and/or hair.

3. Patients must display at least one sign at the time of assessment in two (clinical) or three or more (research) of the following categories:

a. Sensory: hyperalgesia, (that is, exaggerated pain to a painful stimulus, such as pinprick) and/or allodynia (that is, pain elicited by a normally non-painful stimulus, such as light touch and/or deep somatic pressure and/or joint movement).

b. Vasomotor: temperature asymmetry and/or skin color changes and/or asymmetry.

c. Sudomotor/edema: edema and/or sweating changes and/or sweating asymmetry.

d. Motor/trophic: decreased range of motion and/or motor dysfunction (weakness, tremor, dystonia) and/or trophic changes involving nails, skin, and/or hair.

4. Signs and symptoms must not be better explained by another diagnosis

Note: Reprinted with permission from Harden RN, Bruehl S, Perez RS, et al. Validation of proposed diagnostic criteria (the “Budapest Criteria”) for Complex Regional Pain Syndrome. Pain. 2010;150(2):268–274.²² Promotional and commercial use of the material in print, digital or mobile device format is prohibited without the permission from the publisher Wolters Kluwer Heath. Please contact [e-mail] for further information.

Table 3 Comparison of selected clinical features in different definitions of complex regional pain syndrome (CRPS)

CRPS terminology	CRPS type 1 Orlando 1994	CRPS type 2 Orlando 1994	CRPS Bruehl 1999	CRPS Budapest 2003
Physical trigger (nerve in type 2)	±	✓
Disproportionate pain, allodynia or hyperalgesia	✓	✓
Disproportionate pain			✓	✓
Signs: swelling/vasomotor/sudomotor	✓	✓
Symptoms: sensory/vasomotor/sudomotor/edema/motor/trophic			4 of 4	≥3 of 4
Signs: sensory/vasomotor/sudomotor/edema			≥1 in ≥2	≥2 of 4
Exclude explanatory pathology	✓	✓	✓	✓
Sensitivity	0.99			0.85
Specificity	0.68			0.69

Notes: ✓ = present; ± = may or may not be present.

Table 4 Previous staging criteria for severe complex regional pain syndrome

Stage	Characteristics	Time-frame
1	Pain, tenderness, swelling, vasomotor, sudomotor changes	Acute
2	Dystrophic changes	Several months
3	Atrophic changes	Long-term

Table 5 Characteristics of complex regional pain syndrome (CRPS) compared to regional pain syndrome

	CRPS type 1 IASP 1994^Citation13	CRPS Budapest 2003^Citation22	Regional pain syndrome
Physical trigger (nerve in type 2)	±		±
Disproportionate pain, allodynia or hyperalgesia	✓
Disproportionate pain		✓	✓
Signs: swelling/vasomotor/sudomotor	✓
Symptoms: sensory/vasomotor/sudomotor/edema/motor/trophic		≥3 of 4	±
Signs: sensory/vasomotor/sudomotor/edema		≥2 of 4	±
Exclude explanatory pathology	✓	✓	✓

Notes: ✓= present; ± = may or may not be present.

Abbreviation: IASP, International Association for the Study of Pain.

Table 6 Comparative clinical features of complex regional pain syndrome (CRPS), regional pain syndrome, and fibromyalgia

	CRPS Budapest 2003^Citation22	Regional pain syndrome	Fibromyalgia
Pain distribution	Regional	Regional	Wide-spread
Sensory	✓✓	✓	✓
Vascular	✓✓	✓	✓
Edema/sweating	✓✓	✓	✓
Motor/trophic	✓✓	✓	✓
Emotional distress	✓	✓	✓
Exclude explanatory pathology	✓	✓	✓

Notes: ✓= present, ✓✓ = present and more marked.

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MerskeyHBogdukNClassification of Chronic Pain: Description of Chronic Pain Syndromes and Definitions of Pain TermsSeattleIASP Press1994

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