Diagnostic Considerations

The International Association for the Study of Pain (IASP) has developed criteria (also known as the Budapest criteria) for the clinical diagnosis of complex regional pain syndrome and continues to update these criteria.^[11]Current IASP criteria are presented below.

A clinical diagnosis can be made when four criteria are met. The first is continuing pain that is disproportionate to any inciting event.

Second, the patient must report at least one symptom in at least three of the following categories:

Sensory: Hyperalgesia, allodynia
Vasomotor: Temperature asymmetry, skin color changes, skin color asymmetry
Sudomotor/edema: Edema, sweating changes, sweating asymmetry
Motor/trophic: Decreased range of motion, motor dysfunction (eg, weakness, tremor, dystonia), trophic changes (eg, hair, nail, skin)

Third, at time of evaluation the clinician must observe at least one sign in at least two of the following categories:

Sensory: Evidence of hyperalgesia (to pinprick), allodynia (to light touch, temperature sensation, deep somatic pressure, joint movement)
Vasomotor: Evidence of temperature asymmetry (> 1° C), skin color changes or asymmetry
Sudomotor/edema: Evidence of edema, sweating changes, or sweating asymmetry
Motor/trophic: Evidence of decreased range of motion, motor dysfunction (eg, weakness, tremor, dystonia), trophic changes (eg, hair, nail, skin)

Fourth, there must be no other diagnosis that better explains the signs and symptoms

Differential diagnosis

Differential diagnostic considerations include the following^[12]:

Infection (of bone, soft tissue, joint, or skin)
Orthopedic malfixation
Joint instability
Arthritis or arthrosis
Bone or soft tissue injury (eg, stress fracture, instability, ligament damage)
Compartment syndrome
Neural injury (peripheral nerve damage, including compression or entrapment, or central nervous system or spinal lesions), or neuropathy (such as from diabetes mellitus or alcohol misuse)
Thoracic outlet syndrome (due to nerve or vascular compression)
Arterial insufficiency (usually after preceding trauma, atherosclerosis in older people, or thrombangiitis obliterans [Burger disease])
Raynaud syndrome
Lymphatic or venous obstruction
Gardner–Diamond syndrome
Brachial neuritis or plexitis (Parsonage-Turner syndrome or neuralgic amyotrophy)
Erythromelalgia (may include all limbs)
Self-harm

Differential Diagnoses

Workup

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Author

T P Sudha Rao, MD Associate Professor of Medicine, Virginia Commonwealth University School of Medicine; Chief, Rheumatology Fellowship Coordinator, Department of Rheumatology, McGuire VA Medical Center

T P Sudha Rao, MD is a member of the following medical societies: American College of Rheumatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Lawrence H Brent, MD Associate Professor of Medicine, Sidney Kimmel Medical College of Thomas Jefferson University; Chair, Program Director, Department of Medicine, Division of Rheumatology, Albert Einstein Medical Center

Lawrence H Brent, MD is a member of the following medical societies: American Association for the Advancement of Science, American Association of Immunologists, American College of Physicians, American College of Rheumatology

Disclosure: Stock ownership for: Johnson & Johnson.

Chief Editor

Herbert S Diamond, MD Visiting Professor of Medicine, Division of Rheumatology, State University of New York Downstate Medical Center; Chairman Emeritus, Department of Internal Medicine, Western Pennsylvania Hospital

Herbert S Diamond, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of Rheumatology, American Medical Association, Phi Beta Kappa

Disclosure: Nothing to disclose.

Additional Contributors

Don R Revis, Jr, MD Consulting Staff, Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Florida College of Medicine

Don R Revis, Jr, MD is a member of the following medical societies: American College of Surgeons, American Society for Aesthetic Plastic Surgery, American Society of Plastic Surgeons, American Medical Association

Disclosure: Nothing to disclose.

Robert E Wolf, MD, PhD Professor Emeritus, Department of Medicine, Louisiana State University School of Medicine in Shreveport; Chief, Rheumatology Section, Medical Service, Overton Brooks Veterans Affairs Medical Center

Robert E Wolf, MD, PhD is a member of the following medical societies: American College of Rheumatology, Arthritis Foundation, Society for Leukocyte Biology

Disclosure: Nothing to disclose.

Elliot Goldberg, MD Dean of the Western Pennsylvania Clinical Campus, Professor, Department of Medicine, Lewis Katz School of Medicine at Temple University

Elliot Goldberg, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of Rheumatology

Disclosure: Nothing to disclose.