Tuesday, May 21, 2013

Demographic and medical parameters in the development of CRPS type 1

I'm pointing to another freely available article with great content, but, as is often the case, I've an ulterior motive.

The Rosetta Stone

It surely is as important to learn to predict and thereby, hopefully, learn to prevent the development of CRPS -- of whatever type.  In order to conduct this study, which reviewed almost 600 fracture patients, the authors were cognizant of the changes in the wind regarding diagnosis criteria and included results using "Harden and Bruehl criteria..., the International Association for the Study of Pain criteria, and... the criteria of Veldman."

For some helpful before-reading reading on the three criteria, give THIS a quick read first.

It's as close as we can get to seeing the three at work side by side, and it's provocative.

Here is the abstract, and I encourage you to read the whole thing (just click on the title):

Demographic and medical parameters in the development of complex regional
pain syndrome type 1 (CRPS1): Prospective study on 596 patients with a fracture

Annemerle Beerthuizena,⇑
Dirk L. Stronks b
Adriaan van’t Spijker a
Ameeta Yakshb
Barbara M. Hanraets b
Jan Kleinc
Frank J.P.M. Huygenb

a Department of Medical Psychology and Psychotherapy, Erasmus MC, Rotterdam, The Netherlands
b Department of Anesthesiology and Pain Management, Erasmus MC, Rotterdam, The Netherlands
c Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands


Limited data are available on the incidence of complex regional pain syndrome type 1 (CRPS1) and on
demographic and medical risk factors for the development of CRPS1. The objective of this study was to
investigate the incidence of CRPS1 in patients with a fracture using 3 sets of diagnostic criteria and to
evaluate the association between demographic/medical factors and the development of CRPS1 diagnosed
with the Harden and Bruehl criteria. A prospective multicenter cohort study of 596 patients (ages
18 years and older) with a single fracture of the wrist, scaphoid, ankle, or metatarsal V, recruited patients
from the emergency rooms of 3 Dutch hospitals. Of the 596 participants, 42 (7.0%) were diagnosed with
CRPS1 according to the Harden and Bruehl criteria, 289 (48.5%) according to the International Association
for the Study of Pain criteria, and 127 (21.3%) according to the criteria of Veldman. 
An analysis of the medical and demographic differences revealed that patients in whom CRPS1 later developed more often had intra-articular fractures, fracture dislocations, rheumatoid arthritis, or musculoskeletal comorbidities. An ankle fracture, dislocation, and an intra-articular fracture contributed significantly to the prediction of the development of CRPS1. No CRPS1 patients were symptom free at 12 months (T3). At baseline, patients with CRPS1 had significantly more pain than patients without CRPS1 (P < .001). The incidence of the diagnosis of CRPS1 after a single fracture depends to a large extent on the diagnostic criteria used. After a fracture, 7% of the patients developed CRPS1 and none of the patients were free of symptoms at 1-year follow-up.

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