Proposed New Diagnostic Criteria for Complex Regional Pain Syndrome

TLDR

The International Association for the Study of Pain’s 1994 CRPS diagnostic criteria were designed to be descriptive and general, aiming to improve clinical communication and research generalizability, but their consensus-only basis and sporadic use have limited their impact and risk over‑ or under‑diagnosis. This update reports progress toward more accurate and valid CRPS diagnostic criteria. The consensus group in Budapest approved and codified empirically validated, statistically derived revisions to the IASP criteria. Validation studies show the revised criteria are sensitive but suffer from poor specificity, leading to overdiagnosis.

Abstract

This topical update reports recent progress in the international effort to develop a more accurate and valid diagnostic criteria for complex regional pain syndrome (CRPS). The diagnostic entity of CRPS (published in the International Association for the Study of Pain's Taxonomy monograph in 1994; International Association for the Study of Pain [IASP]) was intended to be descriptive, general, and not imply etiopathology, and had the potential to lead to improved clinical communication and greater generalizability across research samples. Unfortunately, realization of this potential has been limited by the fact that these criteria were based solely on consensus and utilization of the criteria in the literature has been sporadic at best. As a consequence, the full potential benefits of the IASP criteria have not been realized. Consensus-derived criteria that are not subsequently validated may lead to over- or underdiagnosis, and will reduce the ability to provide timely and optimal treatment. Results of validation studies to date suggest that the IASP/CRPS diagnostic criteria are adequately sensitive; however, both internal and external validation research suggests that utilization of these criteria causes problems of overdiagnosis due to poor specificity. This update summarizes the latest international consensus group's action in Budapest, Hungary to approve and codify empirically validated, statistically derived revisions of the IASP criteria for CRPS.