Rehabilitation Institute of Chicago, Chicago, IL, USA Vanderbilt University School of Medicine, Nashville, TN, USA VU University Medical Center, Amsterdam, The Netherlands Trauma Related Neuronal Dysfunction Consortium (TREND), The Netherlands University Medical Center Mainz, Mainz, Germany Leiden University Medical Center, Leiden, The Netherlands University of Erlangen-Nuremberg, Erlangen, Germany Rush University Medical Center, Chicago, IL, USA Stanford University Medical Center, Stanford, CA, USA Reuth Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Pain. 2010 Dec;151(3):870-876. doi: 10.1016/j.pain.2010.09.031. Epub 2010 Oct 20.
The clinical diagnosis of Complex Regional Pain Syndrome (CRPS) is a dichotomous (yes/no) categorization necessary for clinical decision-making. However, such dichotomous diagnostic categories do not convey an individual's subtle and temporal gradations in severity of the condition, and have poor statistical power when used as an outcome measure in research. This study evaluated the validity and potential utility of a continuous type score to index severity of CRPS. Psychometric and medical evaluations were conducted in 114 CRPS patients and 41 non-CRPS neuropathic pain patients. Based on the presence/absence of 17 clinically-assessed signs and symptoms of CRPS, an overall CRPS Severity Score (CSS) was derived. The CSS discriminated well between CRPS and non-CRPS patients (p<.001), and displayed strong associations with dichotomous CRPS diagnoses using both IASP diagnostic criteria (Eta=0.69) and proposed revised criteria (Eta=0.77-0.88). Higher CSS was associated with significantly higher clinical pain intensity, distress, and functional impairments, as well as greater bilateral temperature asymmetry and thermal perception abnormalities (p's<.05). In an archival prospective dataset, increases in anxiety and depression from pre-surgical baseline to 4 weeks post-knee arthroplasty were found to predict significantly higher CSS at 6- and 12-month follow-up (p's<.05). Results indicate the CSS corresponds with and complements currently accepted dichotomous diagnostic criteria for CRPS, and support its validity as an index of CRPS severity. Its utility as an outcome measure in research studies is also suggested, with potential statistical advantages over dichotomous diagnostic criteria.
复杂性区域疼痛综合征 (CRPS) 的临床诊断是一种必要的二分法（是/否）分类，用于临床决策。然而，这种二分法诊断类别并不能传达个体病情严重程度的微妙和时间上的渐变，并且在作为研究中的结果测量时统计效力较差。本研究评估了一种连续型评分来评估 CRPS 严重程度的有效性和潜在效用。在 114 名 CRPS 患者和 41 名非 CRPS 神经性疼痛患者中进行了心理测量学和医学评估。基于 CRPS 的 17 种临床评估体征和症状的存在/不存在，得出了总体 CRPS 严重程度评分（CSS）。CSS 很好地区分了 CRPS 和非 CRPS 患者（p<.001），并且与使用 IASP 诊断标准（Eta=0.69）和拟议修订标准（Eta=0.77-0.88）的二分法 CRPS 诊断具有很强的关联。较高的 CSS 与显著更高的临床疼痛强度、痛苦和功能障碍相关，以及更大的双侧温度不对称和热知觉异常（p<.05）。在一个档案前瞻性数据集，从术前基线到膝关节置换术后 4 周的焦虑和抑郁增加被发现显著预测了 6 个月和 12 个月随访时的 CSS 更高（p<.05）。结果表明 CSS 与目前接受的 CRPS 二分法诊断标准相对应并补充了这些标准，并支持其作为 CRPS 严重程度的指标的有效性。还建议将其用作研究中的结果测量，与二分法诊断标准相比具有潜在的统计学优势。
