Abstrakt

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

Joseph V Pergolizzi, Jo Ann LeQuang, Sri Nalamachu, Robert Taylor, Ryan W Bigelsen

Chronic regional pain syndrome (CRPS) is a neuropathic pain syndrome that involves both peripheral and central sensitization. Described in the literature as early as 1872, CRPS has been described using different names and different symptoms over the years. Since many neuropathic pain syndromes are rare, complex, and exhibit overlapping signs and symptoms, diagnosing CRPS has been challenging. Recently the Orlando Criteria in 1993, the subsequent Budapest Criteria in 2003 have attempted to provide a more helpful and robust diagnostic framework. However, the multiplicity of signs and symptoms and allowable variations have resulted in a diagnostic template that accommodates what may actually be a wide variety of conditions and obscures a better understanding of CRPS. The Budapest Criteria make CRPS ultimately a diagnosis of exclusion, leaving clinicians with patients who may be CRPS Type I, CRPS Type II or the new CRPS-NOS. CRPS can be challenging to treat and many treatments are ineffective, possibly owing to the fact that the syndrome is currently defined in such a diffuse way. The current diagnostic criteria of CRPS have even called the entire syndrome into question. There is an urgent need to better define and describe CRPS so that it can be appropriately diagnosed and its mechanisms elucidated. That step will lead to better treatment.