CRPS/RSD Difficult to Diagnose, Harder to Live With
Articles surrounding complex regional pain syndrome/reflex sympathetic dystrophy (CRPS/RSD) often describe the disorder as “painful,” “misunderstood,” and “difficult to treat” for one very important reason: like fibromyalgia, low back pain, or even a simple headache, CRPS/RSD is a human condition without reliable animal models, and is usually considered to be a single disease entity that should respond to standardized treatment.
Unfortunately, if often does not.
Diagnostic tests to support a positive CRPS/RSD diagnosis are rare, and many would say they do not exist. There are no MRI indications for CRPS/RSD, plain X-rays will not reveal it, and there are no serum markers. Only 3-phase bone scintigraphy can demonstrate an increased bone metabolism in the mineralization phase, with moderate accuracy.
CRPS/RSD Diagnosis Often Complicated
Diagnosing CRPS/RSD is not a simple process, and a correct diagnosis largely depends on the diagnostic criteria used. The International Association for the Study of Pain (IASP) approved diagnostic criteria include:
- Continuing pain disproportionate to any provoking event
- Symptoms present in three of four categories: reports of hyperesthesia and/or allodynia; temperature irregularity and/or skin color changes or asymmetry; edema and/or sweating changes or irregularity; decreased motion and/or motor dysfunction or changes in the hair, nails, or skin
- Must display at least one sign at the time of evaluation in two or three (or more) of the above categories
- There is no other diagnosis that better explains the signs and symptoms
It is common that in the first week after trauma, particular patients who are in severe pain are at risk for CRPS/RSD. Diagnoses made months or even years after the initial trauma due to persistent pain and limb nonuse without documented CRPS/RSD symptoms should usually be questioned, according to an IASP report.