title: Characteristics of complex regional pain syndrome in patients referred to a tertiary pain clinic by community physicians, assessed by the Budapest clinical diagnostic criteria.
abstract: OBJECTIVE
  The aim of this study was to describe the characteristics of patients referred with complex regional pain syndrome (CRPS) diagnosis to a tertiary care pain center.
  
  
  METHODS
  Descriptive chart review study of all patients referred by family physicians or community specialists as having CRPS (2006-2010). Data extraction included demographics, pain ratings, and diagnosis utilizing the Budapest CRPS criteria.
  
  
  RESULTS
  The study population consisted of 54 subjects (male [M] =7, female [F] =47). Only 27.7% were classified as CRPS by the clinical expert. Four additional subjects carrying other diagnoses but found to have CRPS were added to the analysis. The non-CRPS group consisted of 39 subjects (M=8, F=31) and the CRPS group of 19 (M=2, F=17). CRPS patients were statistically significantly more likely to 1) have suffered a fracture; 2) report symptoms in each of the four symptom categories, as well as signs in three or four categories collectively; and 3) have allodynia/hyperalgesia alone or in combination (85/90%) as compared with the non-CRPS group (23/25%, respectively). The non-CRPS group was much more likely to report no symptoms or signs at all in the different symptom and sign categories. Of the 39 non-CRPS patients, 74% had other diagnosable entities (1/3 suffering from specific neuropathic pain conditions, e.g., radiculopathy, diabetic neuropathy, etc. and 2/3 from discreet musculoskeletal entities), while 18% were diagnosed with psychogenic pain disorders including conversion reaction associated with immobility or paralysis.
  
  
  CONCLUSIONS
  Besides fulfilling the Budapest CRPS diagnostic criteria, the most important other factor for diagnosing CRPS is the exclusion of a neuropathic, musculoskeletal, or non-biomedical condition accounting for the presentation.
authors.affiliation: Comprehensive Pain Program, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; Department of Medicine, Division of Physiatry, University of Toronto, Toronto, Ontario, Canada; Krembil Neuroscience Center, Toronto Western Hospital, Toronto, Ontario, Canada.
authors.forename: Angela
authors.initials: A
authors.lastname: Mailis-Gagnon
authors.forename: Shehnaz Fatima
authors.initials: SF
authors.lastname: Lakha
authors.forename: Matti D
authors.initials: MD
authors.lastname: Allen
authors.forename: Amol
authors.initials: A
authors.lastname: Deshpande
authors.forename: Robert Norman
authors.initials: RN
authors.lastname: Harden
mesh_terms: D000328:Adult; D002170:Canada; D020918:Complex Regional Pain Syndromes / Q000175:diagnosis* / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018710:Pain Clinics; D010819:Physician's Role; D012017:Referral and Consultation; D062606:Tertiary Care Centers; D055815:Young Adult
keywords: Budapest CRPS Diagnostic Criteria; CRPS; Chronic Noncancer Pain