Diagnosis of complex regional pain syndrome needs to be tightened

Basler, Michael; Rae, Colin P.; Stewart, Gordon

doi:10.1136/bmj.g4029

Cited by 6 publications

(9 citation statements)

References 6 publications

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“…It has been claimed that CRPS is overdiagnosed (11,44,304,306). Although it is not directly comparable, our results with delayed diagnosis will rather indicate the opposite.…”

Section: -2 Weeks (267)contrasting

confidence: 65%

“…Delay and other diagnostic challenges in CRPS in primary care are also documented, and may indicate a lack of knowledge regarding CRPS, risk factors and diagnostic criteria (145,161,(304)(305)(306). The CRPS diagnosis can be defined without the patients meeting the criteria, and conversely, CRPS patients are misdiagnosed with another condition (304,305,307).…”

Section: Discussionmentioning

confidence: 99%

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Importance of early diagnosis of complex regional pain syndrome (CRPS-1 and CRPS-2): Delayed diagnosis of CRPS is a major problem

Breivik

Stubhaug

2016

Scandinavian Journal of Pain

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Recently, two other large retrospective, epidemiological studies were conducted, both of which were published in 2018. Ott and Maihofner included 1,043 CRPS patients from a 12German population (Erlangen -Nuremberg) in the period 1993 -2014, and found a total incidence (CRPS 1 and 2) of 13.6 per 100,000 person-years (2). Kim and colleagues identified a total of 74,349 CRPS patients in a Korean population of 51,448,491 (subscribers to the National Health Insurance Service) between 2011 and 2015, with a corresponding overall incidence (CRPS type 1 and 2) estimated at 29.0 per 100,000 person-years (25). The incidence of CRPS type 1 and 2 was 20.3 and 16.1 per 100,000 person-years, respectively (25). In the Korean study, patients were diagnosed according to the Persistent Disability and Assessment Guidelines by the American Medical Association rather than the Budapest or IASP criteria (25). In the German study, the diagnosis was made by Dr. Maihofner according to the diagnostic criteria considered valid at the time (IASP or Budapest criteria) (2).Regarding the prevalence of CRPS, it is relevant to refer to two large population-based, retrospective studies from the United States that were published in 2017. The largest study included 33,406,123 patients in the period 2007 -2011 and showed that 22,533 patients were discharged with a diagnosis of CRPS type 1, which corresponds to a period prevalence of 0.07% ( 26). The smaller study (period 2000 -2012) reported a total prevalence of 1.2% (CRPS type 1 and 2) in a material consisting of 6,575,999 patients (27). Differences in epidemiological data between studies may be conditioned by factors such as ethnicity, access to health services, age composition, socio-economic status and especially different use of diagnostic criteria (3, 12, 23, 28). Before the IASP criteria were established, the diagnosis of CRPS, which is a clinical diagnosis, was made on a variable foundation with diffuse criteria with a large degree of individual interpretation (15,(29)(30)(31). Furthermore, less accepted criteria have been presented by both Veldman (1993) (6) and Bruehl (1999) (24). Later (2010), the "Budapest criteria" have been established (5). Advantages and disadvantages of the different diagnostic criteria, as well as different practices between different therapists constitute a major challenge when incidence and prevalence are to be investigated (2, 23, 28, 30).CRPS type 1 is more common than CRPS type 2 (2, 22). Some have reported differences of up to 88% versus 12% (CRPS type 1) (2), respectively, while the range varies between other studies (22, 25, 32, 33). CRPS affects all age groups, but is common in 40-60-year-olds (3, 6, 22, 25), and with the average age of diagnosis estimated at approximately 50 years (2, 3, 22).The condition is rare in children and epidemiological data are limited (34)(35)(36)

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“…It has been claimed that CRPS is overdiagnosed (11,44,304,306). Although it is not directly comparable, our results with delayed diagnosis will rather indicate the opposite.…”

Section: -2 Weeks (267)contrasting

confidence: 65%

Section: Discussionmentioning

confidence: 99%

Importance of early diagnosis of complex regional pain syndrome (CRPS-1 and CRPS-2): Delayed diagnosis of CRPS is a major problem

Breivik

Stubhaug

2016

Scandinavian Journal of Pain

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“…Seven articles criticize the label "CRPS" for various reasons. [11][12][13][14][15][16][17][18] It is stated that the "label" does not say anything about the underlying pathophysiology and that it medicalizes non-specific symptoms. 11,13,17,18 In the view of Borchers and Gershwin, CRPS is merely a description of signs and symptoms that can be observed in many other diseases, 12 implying that CRPS is not a distinct diagnostic entity.…”

Section: Crps Should Not Be Called Crpsmentioning

confidence: 99%

“…A criticism often mentioned is the lack of validity of the diagnostic criteria for CRPS [11][12][13][14][15]17,18,115 (See Table 4). Several problems are noted, including the specificity, validity, interobserver reliability, and objectivity of the criteria; the presence of different sets of criteria; and lastly the existence of a condition named CRPS-Not Otherwise Specified (NOS).…”

Section: The Diagnostic Criteria Lack Validitymentioning

confidence: 99%

Denying the Truth Does Not Change the Facts: A Systematic Analysis of Pseudoscientific Denial of Complex Regional Pain Syndrome

Bharwani¹,

Kersten²,

Stone³

et al. 2021

JPR

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Several articles have claimed that complex regional pain syndrome (CRPS) does not exist. Although a minority view, it is important to understand the arguments presented in these articles. We conducted a systematic literature search to evaluate the methodological quality of articles that claim CRPS does not exist. We then examined and refuted the arguments supporting this claim using up-to-date scientific literature on CRPS. Methods: A systematic search was conducted in MEDLINE, EMBASE and Cochrane CENTRAL databases. Inclusion criteria for articles were (a) a claim made that CRPS does not exist or that CRPS is not a distinct diagnostic entity and (b) support of these claims with subsequent argument(s). The methodological quality of articles was assessed if possible. Results: Nine articles were included for analysis: 4 narrative reviews, 2 personal views, 1 letter, 1 editorial and 1 case report. Seven points of controversy were used in these articles to argue that CRPS does not exist: 1) disagreement with the label "CRPS"; 2) the "unclear" pathophysiology; 3) the validity of the diagnostic criteria; 4) CRPS as a normal consequence of immobilization; 5) the role of psychological factors; 6) other identifiable causes for CRPS symptoms; and 7) the methodological quality of CRPS research. Conclusion:The level of evidence for the claim that CRPS does not exist is very weak. Published accounts concluding that CRPS does not exist, in the absence of primary evidence to underpin them, can harm patients by encouraging dismissal of patients' signs and symptoms.

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“…Surgical injury is followed by pain, nausea, vomiting, paralytic ileus, risk of cardiopulmonary dysfunctions, and delayed convalescence [1]. Patients no longer tolerate prolonged suffering, and this may lead to demands for solutions that overcome complex problems [2]. The effect of early therapy for postoperative pain should be investigated because the intensity of acute postoperative pain is related to the risk of developing persistent pain [3–5].…”

Section: Introductionmentioning

confidence: 99%

Involvement of Interleukin-10 in Analgesia of Electroacupuncture on Incision Pain

Dai

Sun

et al. 2019

Evidence-Based Complementary and Alternative Medicine

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Objective Postincision pain often occurs after surgery and is an emergency to be treated in clinic. Electroacupuncture (EA) is a Chinese traditional treatment widely used to cure acute or chronic pain, but its mechanism is not clear. Interleukin-10 (IL-10) is a powerful anti-inflammatory cytokine that shows neuroprotective effects in inflammation and injury in the CNS. The present study attempts to reveal that IL-10 is crucial for EA analgesia on postincision pain. Methods A model of incision pain was established in C57BL/6J mice. The pain threshold was detected by behavioral test, and the expression of IL-10 and its receptor was detected by an immunohistochemical method. C-fiber-evoked field potentials were recorded by in vivo analysis. Results The mechanical allodynia induced by paw incision was significantly inhibited by pretreatment of EA in mice. Intrathecal injection of IL-10 neutralizing antibody (2 µg/10 µL) but not intraplantar injection (10 µg/10 µL) reversed the analgesia of EA. The upregulations of IL-10 mRNA and protein were induced by EA at 6 h and 1 d after incision, respectively. Spinal long-term potentiation (LTP), a substrate for central sensitization, was also suppressed by EA with IL-10. IL-10 recombinant protein (1 µg/10 µL, i.t.) mimicked the analgesia of EA on mechanical allodynia and inhibition on the spinal LTP. Posttreatment of EA after incision also transitorily relieved the mechanical allodynia, which can be blocked by spinal IL-10 antibody. IL-10 and its receptor, IL-10RA, are predominantly expressed in the superficial spinal astrocytes. Conclusions These results suggested that pretreatment of EA effectively prevented postincision pain and IL-10 in spinal astrocytes was critical for the analgesia of EA and central sensitization.

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Diagnosis of complex regional pain syndrome needs to be tightened

Cited by 6 publications

References 6 publications

Importance of early diagnosis of complex regional pain syndrome (CRPS-1 and CRPS-2): Delayed diagnosis of CRPS is a major problem

Importance of early diagnosis of complex regional pain syndrome (CRPS-1 and CRPS-2): Delayed diagnosis of CRPS is a major problem

Denying the Truth Does Not Change the Facts: A Systematic Analysis of Pseudoscientific Denial of Complex Regional Pain Syndrome

Involvement of Interleukin-10 in Analgesia of Electroacupuncture on Incision Pain

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