HISTORY OF RSD / CRPS DIAGNOSIS

 

~1994~

RSD / CRPS Diagnostic Criteria (International Association for the Study of Pain - IASP)

 

In 1994, a consensus group of pain medicine experts gathered by the International Association for the Study of Pain (IASP) agreed on diagnostic criteria for reflex sympathetic dystrophy (RSD) and causalgia, and renamed them complex regional pain syndrome (CRPS) types I and II, respectively.

 

Merskey H, Bogduk N. Classification of Chronic Pain: Descriptions of Chronic Pain Syndromes and Definitions of Pain Terms. Seattle, Wash: IASP Press; 1994.

IASP 1994 DIAGNOSTIC CRITERIA

 

• The presence of an initiating noxious event, or a cause of immobilization. Continuing pain, allodynia or hyperalgesia with which the pain is disproportionate to the inciting event.
• Evidence at some time for edema, changes in skin blood flow, or abnormal sudomotor activity in the region of the pain.
• This diagnosis is excluded by the existence of conditions that would otherwise account for the degree of pain and dysfunction.

 

1994 CRPS Associated Symptoms & Signs (IASP)

 

• Atrophy of skin, nails, and other soft tissues, alterations in hair growth, and loss of joint mobility may develop. *
• Impairment of motor function. *

* Both clinical findings had been reported in several papers prior RSD Diagnostic Criteria but not included in IASP Revised Criteria of 1994.

 

 

~1999~

Proposed Experimental Revision of

RSD / CRPS Diagnostic Criteria ¶

 

(1) Continuing pain which is disproportionate to any inciting event

 

(2) Must report at least one symptom in each of the four following categories

• Sensory: reports of hyperesthesia
• Vasomotor: reports of temperature asymmetry and/or skin color changes and/or skin color asymmetry
• Sudomotor/edema: reports of edema and/or sweating changes and/or sweating asymmetry
• Motor/trophic: reports of decreased range of motion and/or motor dysfunction (weakness, tremor, dystonia) and/or trophic changes (hair, nail, skin)

 

(3) Must display at least one sign in two or more of the following categories:

• Sensory: evidence of hyperalgesia (to pinprick) and/or allodynia (to light touch)

• Vasomotor: evidence of temperature asymmetry and/or skin color changes and/or. asymmetry
• Sudomotor/edema: evidence of edema and/or sweating changes and/or sweating asymmetry
• Motor/trophic: evidence of decreased range of motion and/or motor dysfunction (weakness, tremor, dystonia) and/or trophic changes (hair, nail, skin)

 

¶ These “Experimental” diagnostic criteria are intended for application to research protocols. The experimental diagnostic criteria are NOT intended for the diagnosis of RSD / CRPS in patients with chronic pain.

Proposed New CRPS Research Criteria

Bruehl, Harden, Galer, et al. Pain 1999;81 :147-154

ARTICLE is available:

http://www.iasp-pain.org/journal.html

 

~2003~

RSD / CRPS Diagnostic Criteria (International

Research Foundation for RSD / CRPS)

 

• The presence of an initiating noxious event, or a cause of immobilization. Continuing pain, allodynia or hyperalgesia with which the pain is disproportionate to the inciting event.

• Evidence at some time for edema, changes in skin blood flow, abnormal sudomotor activity, impairment of motor function* or changes in tissue growth (dystrophy and atrophy)* in the region of the pain.
• This diagnosis is excluded by the existence of conditions that would otherwise account for the degree of pain and dysfunction.

 

* Both of these symptoms/ signs (impaired motor and trophic changes) had been in several RSD Diagnostic Criteria prior to the 1994. However, they were not included in IASP Revised Criteria of 1994. In 2003, the Foundation’s Scientific Advisory Committee felt it important to include them in the new diagnostic criteria. In 1999, investigators found that motor and trophic (dystrophy and atrophy) changes were statistically distinct signs/symptoms. They stated that “motor and trophic changes may be an important and distinct component of CRPS which are not currently incorporated in the IASP diagnostic criteria”.

Complex regional pain syndrome: are the IASP diagnostic criteria valid and sufficiently comprehensive?

Harden, Bruehl, Galer et al. PAIN 1999; 83:211-219

ARTICLE is available:

http://www.iasp-pain.org/journal.html

 

For the Foundation's diagnostic criteria and a list of members of its Scientific Advisory Committee:

http://www.rsdfoundation.org/en/en_clinical_practice_guidelines.html

http://www.rsdfoundation.org/en/en_sac.html