Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, Tokyo, Japan Department of Anesthesiology and Intensive Care Medicine, Osaka University, Graduate School of Medicine, Osaka, Japan Department of Pain Medicine, Osaka University, Graduate School of Medicine, Osaka, Japan.
Pain. 2010 Aug;150(2):243-249. doi: 10.1016/j.pain.2010.03.032. Epub 2010 May 6.
Complex regional pain syndrome (CRPS) is a syndrome that describes a broad spectrum of sensory, motor and autonomic-like features with unproven etiology. The International Association for the Study of Pain (IASP) diagnostic criteria of CRPS shows high sensitivity but poor specificity. Using statistical-pattern-recognition methods, American researchers have suggested a new set of criteria offering acceptable sensitivity and high specificity. However, non-American CRPS patients present distinct subsets of CRPS-related signs/symptoms from those of American patients. Here, we followed a series of American studies to develop a set of CRPS diagnostic criteria that would be most suitable for the Japanese population. A standardized sign/symptom checklist was used in patient evaluations to obtain data on CRPS-related signs/symptoms in 195 participants meeting the IASP criteria. Using factor analysis, we grouped CRPS-related signs/symptoms into five distinct subgroups (trophic change, motor dysfunction, abnormal pain processing, asymmetric sudomotor activity and asymmetric edema). Discriminant function analysis of these subgroups, regarding their ability to discriminate between CRPS and non-CRPS etiology, indicated that modifying the IASP criteria could increase clinical diagnostic accuracy in the Japanese population. Our diagnostic criteria are not exactly the same as the American criteria, indicating a need for more regionally based CRPS diagnostic criteria. Different sets of CRPS diagnostic criteria could lead to dissimilar patients being diagnosed as CRPS, however, presenting problems for translation of therapeutic effects found in various studies. Therefore, we further recognize a need for a global set of common CRPS diagnostic criteria.
复杂性区域疼痛综合征（CRPS）是一种描述广泛感觉、运动和自主样特征的综合征，其病因尚未得到证实。国际疼痛研究协会（IASP）的 CRPS 诊断标准具有较高的敏感性但特异性较差。美国研究人员使用统计模式识别方法提出了一组新的标准，具有可接受的敏感性和高特异性。然而，非美国的 CRPS 患者表现出与美国患者不同的 CRPS 相关体征/症状子集。在这里，我们遵循一系列美国研究，制定了一套最适合日本人群的 CRPS 诊断标准。在对 195 名符合 IASP 标准的患者进行评估时，使用标准化的体征/症状检查表获取与 CRPS 相关的体征/症状数据。使用因子分析，我们将 CRPS 相关的体征/症状分为五个不同的亚组（营养变化、运动功能障碍、异常疼痛处理、不对称汗腺活动和不对称水肿）。这些亚组的判别函数分析，关于它们区分 CRPS 和非 CRPS 病因的能力，表明修改 IASP 标准可以提高日本人群的临床诊断准确性。我们的诊断标准与美国标准不完全相同，这表明需要更多基于地区的 CRPS 诊断标准。不同的 CRPS 诊断标准集可能导致不同的患者被诊断为 CRPS，但这会给在各种研究中发现的治疗效果的翻译带来问题。因此，我们进一步认识到需要制定一套全球性的通用 CRPS 诊断标准。
