title: Intense pain soon after wrist fracture strongly predicts who will develop complex regional pain syndrome: prospective cohort study.
abstract: Complex regional pain syndrome (CRPS) is a distressing and difficult-to-treat complication of wrist fracture. Estimates of the incidence of CRPS after wrist fracture vary greatly. It is not currently possible to identify who will go on to develop CRPS after wrist fracture. In this prospective cohort study, a nearly consecutive sample of 1,549 patients presenting with wrist fracture to 1 of 3 hospital-based fracture clinics and managed nonsurgically was assessed within 1 week of fracture and followed up 4 months later. Established criteria were used to diagnose CRPS. The incidence of CRPS in the 4 months after wrist fracture was 3.8% (95% confidence interval = 2.9-4.8%). A prediction model based on 4 clinical assessments (pain, reaction time, dysynchiria, and swelling) discriminated well between patients who would and would not subsequently develop CRPS (c index .99). A simple assessment of pain intensity (0-10 numerical rating scale) provided nearly the same level of discrimination (c index .98). One in 26 patients develops CRPS within 4 months of nonsurgically managed wrist fracture. A pain score of ≥5 in the first week after fracture should be considered a "red flag" for CRPS.
  
  
  CONCLUSIONS
  This study shows that excessive baseline pain in the week after wrist fracture greatly elevates the risk of developing CRPS. Clinicians can consider a rating of greater than 5/10 to the question "What is your average pain over the last 2 days?" to be a "red flag" for CRPS.
authors.affiliation: Sansom Institute for Health Research, The University of South Australia, Adelaide, Australia; Neuroscience Research Australia, Randwick, New South Wales, Australia; Department of Physiology, Anatomy & Genetics, University of Oxford, Oxford, United Kingdom. Electronic address: Lorimer.Moseley@unisa.edu.au.
authors.forename: G Lorimer
authors.initials: GL
authors.lastname: Moseley
authors.affiliation: Neuroscience Research Australia, Randwick, New South Wales, Australia; The University of Sydney, Darlington, New South Wales, Australia.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Herbert
authors.affiliation: Department of Physiology, Anatomy & Genetics, University of Oxford, Oxford, United Kingdom.
authors.forename: Timothy
authors.initials: T
authors.lastname: Parsons
authors.affiliation: Department of Physiology, Anatomy & Genetics, University of Oxford, Oxford, United Kingdom.
authors.forename: Samantha
authors.initials: S
authors.lastname: Lucas
authors.affiliation: Leiden University Medical Center, Albinusdreef, Leiden, The Netherlands; Trauma RElated Neuronal Dysfunction Consortium (TREND), The Netherlands.
authors.forename: Jacobus J
authors.initials: JJ
authors.lastname: Van Hilten
authors.affiliation: Trauma RElated Neuronal Dysfunction Consortium (TREND), The Netherlands.
authors.forename: Johan
authors.initials: J
authors.lastname: Marinus
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002422:Causalgia / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010146:Pain / Q000209:etiology*; D011237:Predictive Value of Tests; D011885:Radius Fractures / Q000150:complications*; D014953:Wrist / Q000294:innervation; D055815:Young Adult
keywords: Complex regional pain syndrome; chronic pain; dysynchiria; reflex sympathetic dystrophy