Validity of the Budapest Criteria For Poststroke Complex Regional Pain Syndrome

Abstract

Objectives: Complex regional pain syndrome-1 is a chronic neuropathic disorder, and poststroke complex regional pain syndrome (PS-CRPS) is not a rare complication. There is a lack of study implementing the Budapest criteria for PS-CRPS diagnosis. Thus, the present study investigated the validity of the Budapest criteria for PS-CRPS diagnosis and assessed the PS-CRPS–related factors in stroke patients with an affected upper extremity. Methods: The study included 72 patients with first-ever stroke resulting in hemiplegia. The prevalence of PS-CRPS and diagnostic validity were compared among the Budapest clinical criteria, Budapest research criteria, modified Budapest criteria (removal of the motor factor from the motor/trophic category), and International Association for the Study of Pain (IASP) criteria in patients diagnosed with PS-CRPS according to the Budapest clinical criteria. Results: PS-CRPS was diagnosed in 6 (8.3%), 1 (1.4%), 6 (8.3%), and 11 patients (15.3%) according to the Budapest clinical criteria, Budapest research criteria, modified Budapest criteria, and IASP criteria, respectively. The Budapest criteria and IASP criteria had sensitivities of 0.99 and 1.00, respectively, and specificities of 0.68 and 0.41, respectively, for PS-CRPS diagnosis. There were no differences in risk factors between PS-CRPS patients and non–PS-CRPS patients when the diagnosis was based on the Budapest clinical criteria. However, there were differences in muscle strength and Brunnstrom stage between PS-CRPS patients and non–PS-CRPS patients when the diagnosis was based on the IASP criteria. Discussion: Our findings indicate that the diagnostic validity of the current Budapest clinical criteria for PS-CRPS is low. Thus, the current Budapest criteria might not be appropriate for PS-CRPS diagnosis.

A Meta-Analysis and Meta-Regression of Frequency and Risk Factors for Poststroke Complex Regional Pain Syndrome

“…Shoulder subluxation was mentioned in 13 articles [4,8,20,21,23,25,26,28,29,31,33,35,36], and 10 articles [4,20,23,26,28,29,31,33,35,36] revealed significant associations. Pooled effect size of eight [4,8,20,23,26,28,33,35] available investigations showed a higher risk of poststroke CRPS with moderate heterogeneity in patients with glenohumeral subluxation (OR, 6.29, 95% CI, 3.116 to 12.696, I 2 = 74.3%, Figure 3).…”

“…Eight investigations assessed spasticity. Four studies [4,21,26,31] measured the severity of spasticity in patients with and without poststroke CRPS, while the other four [8,20,35,36] compared the proportion of participants with signs of spasticity between groups. Five of the eight articles [4,20,26,31,36] reached statistical significance.…”

“…Some investigations have revealed early rehabilitation may decrease the likelihood of The initial search showed 1501 articles. Twenty-one studies [4,8,[20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] underwent a qualitative synthesis (Figure 1). The main features of the included trials are summarized in Table 1.…”

“…Three cohort studies [31,32,37], eight nested case-control studies [8,20,23,24,26,30,35,36], and ten cross-sectional studies [4,21,22,25,[27][28][29]33,34,38] were enrolled. The number of participants ranged from 20 to 426 subjects.…”

“…The number of participants ranged from 20 to 426 subjects. In eighteen papers [4,8,20,21,[23][24][25][26][28][29][30][31][32][33][35][36][37][38], hospitalized patients were recruited, one [22] investigation enrolled subjects from outpatient clinics, and two researchers [27,34] did not specify whether they recruited participants from inpatient or outpatient departments. Various diagnostic criteria were adopted, including clinical and radiological findings.…”