Diagnosis and management

We have developed a short video for therapists and other healthcare professionals, which can be viewed below and was created as result of findings from the ENACT-CRPS research study. Our thanks go to the University of the West of England for their funding support and technical expertise.

The Budapest Criteria

There is currently no single test that can definitively diagnose CRPS. However, the International Association for the Study of Pain (IASP) have adopted a set of diagnostic guidelines, known as the Budapest Criteria. These differentiate between signs and symptoms - signs are observed by the healthcare professional carrying out the assessment examination, whilst symptoms are what is reported by the patient.

Early diagnosis and treatment is considered best practice in order to help avoid secondary problems or persistent CRPS. To receive a diagnosis of CRPS, a person must have:

Continuing pain which is disproportionate to any inciting event
At least one sign in two or more categories
At least one symptom in three or more categories
No other diagnosis that can better explain the signs and symptoms.

Symptoms

Sensory - hyperaesthesia and/or allodynia.
Vasomotor - skin colour changes and/or temperature asymmetry in the affected limb.
Sudomotor/ oedema - swelling or sweating changes in the affected limb, sweating asymmetry.
Motor/ trophic - decreased range of motion and/or motor dysfunction (tremor, weakness, dystonia). Trophic changes include alterations to hair, nails or skin.

Signs

Sensory - hyperalgesia (to pinprick), heightened sensitivity to pain and/or allodynia to light touch or deep somatic pressure.
Vasomotor - temperature differences between the affected and non-affected limb, and/or skin colour changes. Temperature asymmetry much be >1 degree Celsius.
Sudomotor/ oedema - swelling and/or sweating changes, sweating asymmetry.
Motor/ trophic - decreased range of motion and/or motor dysfunction (weakness, tremor, dystonia), and/or nail, hair or skin changes.

Limb signs usually reduce with time, even where pain and motor symptoms persist. However, reduction of limb signs is in itself not 'recovery'. Where pain persists, the condition is best considered to be active. Following the Valencia consensus-based adaptation of the Budapest Criteria in 2021, patients who have fulfilled the criteria in the past and have ongoing pain, but have now lost some some or all limb signs, may be classified as 'CRPS with Remission of Some Features'. Patients who display some but not all features of CRPS required for formal diagnosis, but no other condition better explains the clinical features, may be termed CRPS-NOS (not otherwise specified).

The CRPSAssist app

A small group of our members have developed a free online tool, on behalf of European Pain Federation EFIC. This is aimed at therapists who have little or no knowledge of CRPS, helping clinicians to identify patients with CRPS and decide what to do next. Practical tips, common pitfalls and a downloadable copy of the Budapest Criteria are all included. Click on the links below to access the app's features.

Complex Regional Pain Syndome in adults: UK guidelines for diagnosis, referral and management in primary and secondary care (2nd edition, 2018)

This guidance was developed by a panel of experts (including some of our members) and is endorsed by the Royal College of Physicians. It provides recommendations for diagnosis, treatment and referral in a variety of clinical settings. Download a copy of the full guidelines by clicking on the link below.

DOWNLOAD