CRPS Diagnosis Clarification
The patient does not meet diagnostic criteria for Complex Regional Pain Syndrome (CRPS), as this diagnosis requires formal assessment using the Budapest Criteria by a specialist, which has not been performed. 1, 2
Why CRPS Cannot Be Diagnosed in This Case
The diagnosis of CRPS is primarily clinical and requires fulfillment of the Budapest Criteria, which mandates:
- Continuing pain disproportionate to any inciting event 3, 4
- At least one symptom in three of four categories: sensory (hyperalgesia/allodynia), vasomotor (temperature/color asymmetry), sudomotor/edema (sweating changes/edema), and motor/trophic (decreased range of motion/motor dysfunction/trophic changes) 3, 5
- At least one sign at time of evaluation in two or more categories 3, 4
- No other diagnosis that better explains the signs and symptoms 2, 4
Chronic pain and paresthesia alone do not constitute CRPS. 1, 6 These symptoms are nonspecific and can occur in numerous conditions including peripheral neuropathy, radiculopathy, fibromyalgia, and other regional pain syndromes. 7
What Assessment Would Be Required
If CRPS were suspected, the following would be necessary:
- Specialist evaluation (pain medicine, neurology, or physiatry) to formally apply Budapest Criteria 1, 2
- Documentation of specific features: excruciating burning pain that worsens with touch (allodynia), temperature asymmetry >1°C between limbs, skin color changes, abnormal sweating patterns, motor weakness disproportionate to injury, and trophic changes 1, 6, 8
- Symptom duration: For chronic CRPS specifically, symptoms must be present for at least 12 months 1, 2
- Optional diagnostic testing: Three-phase bone scintigraphy (sensitivity 78%, specificity 88%), quantitative sensory testing, or skin biopsy for intraepidermal nerve fiber density may support diagnosis in uncertain cases 7, 1, 2
Appropriate Next Steps for This Patient
Given the presentation of chronic pain and paresthesia without specialist-confirmed CRPS:
- Refer to appropriate specialist (pain medicine, neurology, or rheumatology) for comprehensive evaluation of chronic pain etiology 7
- Document specific pain characteristics: location, quality, intensity, aggravating/alleviating factors, and associated symptoms 7, 6
- Assess for alternative diagnoses: peripheral neuropathy, radiculopathy, fibromyalgia, or other regional pain syndromes that may better explain symptoms 7, 4
- Initiate multimodal pain management appropriate for chronic pain while diagnostic workup proceeds, including physical therapy and appropriate analgesics 7, 9
The referral has been appropriately corrected to reflect that CRPS has not been diagnosed by a specialist, and the patient's symptoms of chronic pain and paresthesia require proper diagnostic evaluation. 1, 2