Complex Regional Pain Syndrome (CRPS) : Budapest Criteria

Synonyms: CRPS, Sudeck’s atrophy, Reflex sympathetic dystrophy, RSD, Causalgia

Chronic regional pain syndrome (CRPS) is a neuropathic pain syndrome that involves both peripheral and central sensitization. There are 2 types of CRPS. In type 1 (Sudeck’s atrophy or Reflex sympathetic dystrophy – RSD), there is no proven nerve injury while in type 2 (Causalgia), there is a known nerve injury.

Budapest Criteria for Clinical Diagnosis

1. Pain (ongoing and disproportionate to any inciting event)

2. Symptoms (reported): At least 1 symptom in 3/4 of the following categories:

• Sensory – Hyperaesthesia and/or allodynia
• Vasomotor – Temperature asymmetry and/or skin colour changes and/or skin colour asymmetry
• Sudomotor/Edema – Edema 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)

3. Signs (examined): At least one sign in 2/4 of the following categories:

• Sensory – Hyperalgesia (to pinprick) and/or allodynia (to light touch and/or temperature sensation and/or deep somatic pressure and/or joint movement)
• Vasomotor – Temperature asymmetry (> 1 °C) and/or skin colour changes and/or asymmetry
• Sudomotor/Edema – Edema 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)

4. Diagnosis of exclusion: No other diagnosis better explains the signs and symptoms.

It’s features can also be remembered using the mnemonic: STAMP

1. Sensory (Hyperalgesia or Allodynia)
2. Trophic (Skin hair, nail, changes)
3. Autonomic (Swelling, edema, sweating)
4. Motor (Reduced range of motion, weakness, tremor or dystonia)
5. Pain