Abstract
Complex regional pain syndrome (type 1) (CRPS) is a chronically painful and disabling condition commonly encountered following trauma and surgery to an extremity. The condition comprises of a combination of pain, swelling, sensory impairment, joint stiffness, trophic changes, motor abnormalities and vasomotor instability.
Post-traumatic CRPS is a significant clinical problem presenting to the orthopaedic surgeon and pain specialist. A clear understanding of the condition has been hampered by a lack of uniformity of diagnostic criteria (Van de Beek W-JT, et al Neurology2002;58:522–526). Pain therapists use the International Association of Pain (IASP) criteria (Bruehl S et al Pain1999;81:147–154) and orthopaedic surgeons the Atkins criteria (J Bone Joint Surg1990;72B:105–110).
Breuhl’s criteria use a combination of symptoms and signs from 4 distinct groups (hypersensitivity; vasomotor; swelling and sudomotor; motor and trophic).
Atkins’ criteria require the finding of vasomotor instability symptoms, abnormal finger dolorimetry and abnormal finger range of movements.
We have compared these different criteria on a series of 262 patients with distal radial fracture.
The incidence of CRPS was similar using either criteria (Bruehl 20.61% vs. Atkins 22.52%). Using the Bruehl criteria as a gold standard, there was strong diagnostic agreement (Kappa = 0.79, sensitivity = 0.87, specificity = 0.94). The main difference between the two methods was in pain assessment. 16 patients had vasomotor instability, swelling and motor changes but 12 did not complain of hypersensitivity although the dolorimetry ratio was lowered. These cases have CRPS by the Atkins criteria but not the Bruehl. In contrast 4 of these cases had normal finger dolorimetry but abnormal forearm hypersensitivity and therefore had CRPS by the Bruehl criteria and not the Atkins.
These finding show that the Bruehl and Atkins criteria are basically concordant. The differences reflect only minor variations in the assessment of pain. Agreement between researchers in the orthopaedic and pain therapy communities will allow improved understanding of the pathophysiology, possible prevention and future methods of managing CRPS.
Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
