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Complexe regionale pijn syndromen, CRPS (dystrofie): diagnose

De onderstaande tabel is het meest recente overzicht van de criteria voor de diagnose complex regional pain syndroom. Deze criteria verschenen in:

Harden RN, Bruehl S, Stanton-Hicks M, Wilson PR. Proposed new diagnostic criteria for complex regional pain syndrome. Pain Med 2007; 8: 326–331

Hiernaast een oude afbeelding van een plexus van de arm.

Proposed clinical diagnostic criteria for CRPS (the 'Budapest criteria')

^[1]

De algemene definitie van CRPS

Onder CRPS vallen pijnen die gekarakteriseerd worden door een continue (spontaan of uitgelokt) regionale pijn, welke disproportioneel lijkt qua duur of gezien het trauma. De pijn is regionaal (niet specifiek in alleen in een gebied geinnerveerd door een bepaalde zenuw of in een bepaalde dermatoom) en wordt vaak gekarakteriseerd door abnormale gevoelens, verminderde kracht, bloedvatverwijdingen of -vernauwingen (roodheid of bleekheid), autonome disregulaties (o.a. meer zweten, versterkte haargroei) Het syndroom heeft een grillig verloop in de tijd.

De orginele tekst in het Engels:

CRPS describes an array of painful conditions that are characterized by a continuing (spontaneous and/or evoked) regional pain that is seemingly disproportionate in time or degree to the usual course of any known trauma or other lesion. The pain is regional (not in a specific nerve territory or dermatome) and usually has a distal predominance of abnormal sensory, motor, sudomotor, vasomotor, and/or trophic findings. The syndrome shows variable progression over time.

To make theclinical diagnosis, the following criteria must be met.

1. Continuing pain, which is disproportionate to any inciting event

2. Must report at least one symptom in three of the four following categories
- Sensory: reports of hypaesthesia and/or allodynia
- Vasomotor: reports of temperature asymmetry and/or skin color changes and/or skin color asymmetry
- Sudomotor/edema: reports of edema and/or sweating changes and/or sweating asymmetry
- Motor/trophic: reports of decreased range of motion and/or motor dysfunction (weakness, tremor, dystonia) and/or trophic changes (hair, nail, skin)

3. Must display at least one sign at time of evaluation in two or more of the following categories
- Sensory: evidence of hyperalgesia (to pinprick) and/or allodynia (to light touch and/or temperature sensation and/or deep somatic pressure and/or joint movement)
- Vasomotor: evidence of temperature asymmetry (>1°C) and/or skin color changes and/or asymmetry
- Sudomotor/edema: evidence of edema and/or sweating changes and/or sweating asymmetry
- Motor/trophic: evidence of decreased range of motion and/or motor dysfunction (weakness, tremor, dystonia) and/or trophic changes (hair, nail, skin)

4. There is no other diagnosis that better explains the signs and symptoms

Deze criteria voor CRPS zijn onlangs gevalideerd.^[2]

Voor de volledigheid:

De IASP (International Association for the Study of Pain) definitie: "CRPS Type I is a syndrome that usually develops after an initiating noxious event, is not limited to the distribution of a single peripheral nerve, and is apparently disproportioned to the inciting event. It is associated at some point with evidence of oedema, changes in skin blood flow, abnormal sudomotor activity in the region of the pain, or allodynia or hyperalgesia"

Oktober 2012, prof. dr. Jan M. Keppel Hesselink en David J. Kopsky
revisie maart 2012 DJK

Referenties

[1]: Harden RN, Bruehl S, Stanton-Hicks M, Wilson PR. | Proposed new diagnostic criteria for complex regional pain syndrome. | Pain Med. | 2007 May-Jun;8(4):326-31.

[2]: Pabón Osuna P, Ledesma García C, Castaño Bazo L, Santos Rodríguez I, Sala Sánchez-Castillo A, Cascón Bueno M, Iraola Lacarta JL, Paino Blanco LM, Martin Luengo C, de Castro del Pozo S. | [Right ventricular infarct: contribution of 2 cases]. | Rev Esp Cardiol. | 1979;32(3):299-304.