___________________________________________________ Pain Assessment and Management, 2nd Edition
NEW IASP DIAGNOSTIC CRITERIA FOR CRPS
A-D must apply. A. The patient has continuing pain that is disproportionate to any inciting event. B. The patient reports at least one symptom in three or more of the categories. C. The patient displays at least one sign in two or more of the categories.
D. No other diagnosis can better explain the signs and symptoms. • No other diagnosis can better explain the signs and symptoms. No. Category
Signs/Symptoms
1
Sensory
Allodynia (pain to light touch and/or temperature sensation and/or deep somatic pressure and/or joint movement) and/or hyperalgesia (to pinprick) Temperature asymmetry and/or skin color changes and/or skin color asymmetry
2 3 4
Vasomotor
Sudomotor/odema
Odema and/or sweating changes and/or sweating asymmetry
Motor/trophic
Decreased range of motion and/or motor dysfunction (weakness, tremor, dystonia) and/or trophic changes (hair/nail/skin)
Source: Adapted from Gobel et al. (2021)
Table 3
diagnosis include thermography (a test to show temperature changes and lack of blood supply in the affected limb), limb magnetic resonance imaging (MRI), bone scans, nerve conduc- tion studies, ischemia tests, and X-rays (Birklein & Dimova, 2017). Unfortunately, there is no cure for CRPS, nor is there one treatment that is universally effective; it appears that early diagnosis and a multidisciplinary treatment approach is a key in treating CPRS (Kessler et al., 2020). The limited number of clients, the differences in and changes to the diagnostic criteria, the varied nature of the symptoms, and the fact that it is unknown whether remission is due to treatment or occurs spontaneously makes it difficult to study (Kessler et al., 2020; Palmer, 2015). Recommended treatments include physical and occupational therapy (mobilization, mirror therapy, edema control, desensitization, contrast baths, sensory reeducation, graded strengthening, and functional restoration), psycho- therapy (in particular, cognitive-behavioral therapy [CBT]), biofeedback, medications (including pain medicines, steroids, certain blood pressure medicines, bone loss medicines, and antidepressants), and certain invasive techniques (nerve blocks, pain pumps, stimulators, neuromodulators; Kessler et al., 2020; Palmer, 2015). Because clients and their families often do not know anyone else with the disease and feel isolated and misunderstood, local support groups can be of great help to this population. Physical and occupational therapy practitioners provide educa- tion to help clients with CRPS understand their symptoms and cope better. There is growing support for the use of movement representation techniques, which include mirror therapy and graded motor imagery. Right-left discrimination tasks, employing images of the affected body part, are used to stimulate imagined movements that do not trigger pain. A mirror box may be used to create an illusion that the affected body part is able to move without pain. The client progresses
to explicit thoughts about movement and actual movements using the mirror box. Movement and functional use of the affected body part are encouraged within pain tolerance. This process is used to decrease the perceived threat and assist in reorganizing the cortical map (McGee et al., 2018). FIBROMYALGIA Fibromyalgia is characterized by the disordered processing of painful stimuli. Individuals diagnosed with fibromyalgia have widespread chronic pain accompanied by fatigue, as well as memory, sleep, and emotional and mental distress (Winslow et al., 2023). The prevalence of fibromyalgia in the general population is approximately 0.2% to 6.6% worldwide, including 6.4% of the U.S. population (Marques et al., 2017). Depression and/or anxiety are often associated with fibromy- algia where Henao-Pérez et al. (2022) found 28.75% of the patients had one or both of these diagnoses. The American College of Rheumatology has updated established criteria for the classification of fibromyalgia (Maffei, 2020). A revised fibromyalgia diagnostic criterion was developed and includes (1) generalized pain, defined as pain in at least four of the five regions; (2) symptoms at a consistent level for at least 3 months; and (3) a Widespread Pain Index (WPI) score ≥7 and a Symp- tom Severity Scale (SSS) score ≥5 or WPI of 4-6 and SSS ≥9. A diagnosis of fibromyalgia is considered valid irrespective of other diagnoses, and the presence of other illnesses does not exclude a diagnosis of fibromyalgia (Maffei, 2020). The WPI and the SSS are used to evaluate pain intensity and location (Maria de Oliveira et al., 2023). Individuals with fibromyalgia often experience additional symptoms of sleep disorders, paresthesia, tenderness, stiffness, mood disturbances, anxiety, and complex cognitive dysfunc- tioning (fibro fog) (Maffei, 2020; Sommer, 2010; Wolfe et al., 2010).
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