The Budapest criteria for complex regional pain syndrome: The diagnostic challenge

Complex regional pain syndrome (CRPS) is a chronic pain condition that typically occurs after injury to a limb or directly to a nerve. Progression of the disease can result in multiple debilitating symptoms including pain disproportionate to the inciting event. The Budapest criteria cateforize the constellation of signs and symptoms of CRPS (sensory, vasomotor, sudomotor/edema, and motor/trophic changes) and are used to diagnose the syndrome. Treatments include rehabilitation (physical and occupation therapy), multimodal pain medication (medications that target neuropathic pain such as antidepressants, membrane stabilizers, and ion channel blockers), interventional treatments (sympathetic blocks, infusion catheters, neuromodulation), and psychological therapy.

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Complex regional pain syndrome: An updated comprehensive review

Neurorehabilitation ◽

10.3233/nre-208001 ◽

2020 ◽

Vol 47 (3) ◽

pp. 253-264

Author(s):

Allison Kessler ◽

Min Yoo ◽

Randy Calisoff

Keyword(s):

Complex Regional Pain Syndrome ◽

Treatment Options ◽

Interdisciplinary Approach ◽

Clinical Information ◽

Pain Syndrome ◽

Definitive Treatment ◽

Confirmatory Test ◽

Exact Etiology ◽

Behavioral Therapies ◽

Budapest Criteria

Complex regional pain syndrome (CRPS) is a complex disorder that can have a significant impact on the quality of life of a person with this syndrome. The diagnosis and treatment of CRPS are often difficult as there is no one confirmatory test and no one definitive treatment. Currently, the most widely accepted clinical diagnostic criteria are the Budapest criteria, which were developed by expert consensus. Though no one single treatment has been found to be universally effective, early detection and an interdisciplinary approach to treatment appear to be key in treating CRPS. This review aims to present up-to-date clinical information regarding the diagnosis and management of CRPS and highlight the potential issues with diagnosis in the neurological population. Ultimately, more research is needed to identify the exact etiology of CRPS in order to help target appropriate therapies. In addition, more randomized controlled trials need to be performed in order to test new therapies or combinations of therapies, including pharmacological, interventional, and behavioral therapies, to determine the best treatment options for this potentially debilitating disorder.

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Incidence of Complex Regional Pain Syndrome I Following Foot and Ankle Fractures Using the Budapest Criteria

Pain Medicine ◽

10.1093/pm/pnw055 ◽

2016 ◽

Vol 17 (12) ◽

pp. 2353-2359 ◽

Cited By ~ 4

Author(s):

Michael Bullen ◽

Coran Lang ◽

Phong Tran

Keyword(s):

Complex Regional Pain Syndrome ◽

Pain Syndrome ◽

Ankle Fractures ◽

Foot And Ankle ◽

Budapest Criteria

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Complex regional pain syndrome of the residual limb in a transtibial lower-limb amputee: diagnosis and treatment

BMJ Case Reports ◽

10.1136/bcr-2020-239650 ◽

2021 ◽

Vol 14 (7) ◽

pp. e239650

Author(s):

Christos Karatzios ◽

Francois Luthi ◽

Guillaume Muff ◽

Charles Benaim

Keyword(s):

Complex Regional Pain Syndrome ◽

Lower Limb ◽

Pain Syndrome ◽

Clinical Findings ◽

Lower Limb Amputation ◽

Limb Amputation ◽

Intractable Pain ◽

Residual Limb ◽

Residual Limb Pain ◽

Budapest Criteria

We present the unusual case of complex regional pain syndrome (CRPS) of the residual limb in a 54-year-old woman with transtibial lower-limb amputation. Intractable pain developed 14 months after amputation, followed by successful rehabilitation. Anamnesis and clinical findings included sensory symptoms, vasomotor symptoms and signs, and oedema. The Budapest criteria for a diagnosis of CRPS were met. After infusions of bisphosphonates during a 5-week inpatient interdisciplinary rehabilitation programme, the pain decreased. Clinicians should suspect CRPS in case of chronic or recurrent residual limb pain. The Budapest criteria seem applicable even if interpretation of symptoms and findings can be complicated in vascular polymorbid lower-limb amputation. Bisphosphonates, proposed as first-line pharmacological treatment, can be useful.

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Fracture of the Wrist and Incidence of the Complex Regional Pain Syndrome Type 1: A Case Series Study

Journal of Orthopedic and Spine Trauma ◽

10.18502/jost.v4i4.3098 ◽

2020 ◽

Author(s):

Payam Vezvaei ◽

Soroosh Alizadeh ◽

Saeed Reza Mehrpour ◽

Leila Oryadi-Zanjani

Keyword(s):

Distal Radius Fracture ◽

Complex Regional Pain Syndrome ◽

Distal Radius ◽

Case Series ◽

Pain Syndrome ◽

Radius Fracture ◽

Case Series Study ◽

Budapest Criteria ◽

Series Study

Background: Complex regional pain syndrome (CRPS) is a painful syndrome with signs such as swelling, restriction of motion, and discoloration of the skin and bone. CRPS is divided into two types based on neurological injuries. Type 1 CRPS (CRPS-I), which is more common, has no nerve damage. In this study, we used the Budapest Criteria to investigate the incidence of CRPS. We also evaluated the risk factors for the incidence of CRPS. Methods: This single-center case series study was performed at Shariati Hospital of Tehran University of Medical Sciences, Tehran, Iran, during 2018-2019. We evaluated CRPS-I, two and six weeks after treatment based on Budapest Criteria. The inclusion criteria included distal radius fracture confirmed by clinical and radiographic investigations. The exclusion criteria were patients with fractures in another part of the body, associated nerve damage, vascular injury, and an open fracture. Results: Sixty-two patients with distal radius fracture who underwent casting or surgical treatment enrolled in the study. A total of 9 (14.5%) patients had CRPS-I after distal radius fracture. In 5 (8.1%) patients, CRPS-I occurred within two weeks after fracture. Also, 4 (6.5%) patients had CRPS-I after six weeks from fracture. There was no significant difference between the two sex groups in terms of CRPS (P = 0.345). This complication was significantly higher in the surgical group than in the casting group (P = 0.004). Conclusions: Given the significant incidence of CRPS and its impact on patient's quality of life, further studies are recommended to explore solutions to reduce this complication.

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Effectiveness of prophylactic vitamin C supplementation in the prevention of complex regional pain syndrome after distal end radius fractures in the aging population

Journal of Orthopaedics Trauma and Rehabilitation ◽

10.1177/22104917211056946 ◽

2021 ◽

Vol 28 ◽

pp. 221049172110569

Author(s):

Rohit M Sane ◽

Prakash D Samant ◽

Rajendraprasad R Butala

Keyword(s):

Vitamin C ◽

Complex Regional Pain Syndrome ◽

Standard Therapy ◽

Randomized Study ◽

Pain Syndrome ◽

Aging Population ◽

Radius Fracture ◽

Radius Fractures ◽

Vitamin C Supplementation ◽

Budapest Criteria

Background/purpose Vitamin C has been proposed to prevent the incidence of complex regional pain syndrome, but the results are conflicting. We evaluated the effectiveness of vitamin C in the prevention of complex regional pain syndrome-1 after distal end radius fractures in the aging population. Methods This was a prospective, randomized study. Patients treated with either conservative or surgical management for distal end radius fracture received Vitamin C (500 mg/day) plus standard therapy or standard therapy alone for a period of 3 months. The presence of complex regional pain syndrome-1 was assessed with Budapest criteria. Results The complex regional pain syndrome-I occurred in 11.3% in Vitamin C plus Standard in compared to 26% in Standard therapy alone. Vitamin C was significantly associated with a reduction in the likelihood of exhibiting complex regional pain syndrome-1. Conclusion Vitamin C (500 mg/day) supplementation was effective and associated with a lower occurrence of acute complex regional pain syndrome-1. It can be a promising prophylactic option for the prevention of complex regional pain syndrome-1 after distal end radius fracture.

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Complex Regional Pain Syndrome - Diagnosis, Treatment and Future Perspectives

European Neurological Review ◽

10.17925/enr.2011.06.04.270 ◽

2011 ◽

Vol 6 (4) ◽

pp. 270 ◽

Cited By ~ 2

Author(s):

Sigrid GL Fischer ◽

Roberto SGM Perez ◽

◽

Keyword(s):

Complex Regional Pain Syndrome ◽

Motor Function ◽

Pain Syndrome ◽

Signs And Symptoms ◽

Future Research ◽

Future Perspectives ◽

Central Sensitisation ◽

Anti Inflammatory ◽

Budapest Criteria ◽

Cortical Reorganisation

Complex regional pain syndrome (CRPS) is a pain syndrome of the extremities that can result in severe disability. CRPS is diagnosed using diagnostic Budapest criteria based on signs and symptoms, whereby sensory, autonomic, vasomotor, motor and trophic disturbances are assessed. Many pathophysiological mechanisms are proposed in the development and disease course of CRPS, starting with exaggerated inflammation and resulting in vascular deregulation, central sensitisation and cortical reorganisation. Treatment is based primarily on reducing inflammation by using medicinal anti-inflammatory therapy and increasing motor function by physiotherapy. Furthermore, pain reduction, normalisation of vasomotor and motor function, and psychological interventions might be needed. Future research should focus on the efficacy of anti-inflammatory therapy, effective rehabilitation programmes, modulating neuropathic pain and cortical reorganisation.

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Early Treatment of Acute Complex Regional Pain Syndrome after Fracture or Injury with Prednisone: Why Is There a Failure to Treat? A Case Series

Pain Research and Management ◽

10.1155/2016/7019196 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5 ◽

Cited By ~ 8

Author(s):

Paul Winston

Keyword(s):

Complex Regional Pain Syndrome ◽

Large Scale ◽

Case Series ◽

Pain Syndrome ◽

Acute Injury ◽

Effective Treatment Option ◽

Permanent Disability ◽

Oral Corticosteroids ◽

Promising Treatment ◽

Budapest Criteria

Background. Complex regional pain syndrome (CRPS) after fracture is a cause of pain, dysfunction, and potentially permanent disability. The evidence for treatment with oral corticosteroids is growing and supported by several international guidelines; however, treatment is not widely offered.Objective. Rapid recognition and treatment of complex regional pain in the upper extremity after acute injury as a disease modifying and potentially curative treatment.Methods. The present study was a case series involving three patients who developed CRPS after a trauma to the neck and/or upper limb. Patients were screened by clinical examination and bone scan and met the Budapest criteria.Results. Resolution of pain, swelling, and disability in all three patients.Discussion. There is increasing support, based on the existing evidence and clinical outcomes, for the use of prednisone to treat the acute phase of CRPS and as a promising treatment to halt the progression of the phenomenon and potentially cure the condition; however, widespread use of prednisone likely remains low, potentially resulting in long-term pain, joint contracture, and disability. A large-scale randomized control trial has not been performed.Conclusion. Corticosteroids can be an effective treatment option for CRPS after fracture.

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