Departments of Rehabilitation Medicine.
Neurorehabilitation, National Rehabilitation Center, Seoul, Republic of Korea.
Clin J Pain. 2019 Oct;35(10):831-835. doi: 10.1097/AJP.0000000000000741.
Complex regional pain syndrome-1 is a chronic neuropathic disorder, and poststroke complex regional pain syndrome (PS-CRPS) is not a rare complication. There is a lack of study implementing the Budapest criteria for PS-CRPS diagnosis. Thus, the present study investigated the validity of the Budapest criteria for PS-CRPS diagnosis and assessed the PS-CRPS-related factors in stroke patients with an affected upper extremity.
The study included 72 patients with first-ever stroke resulting in hemiplegia. The prevalence of PS-CRPS and diagnostic validity were compared among the Budapest clinical criteria, Budapest research criteria, modified Budapest criteria (removal of the motor factor from the motor/trophic category), and International Association for the Study of Pain (IASP) criteria in patients diagnosed with PS-CRPS according to the Budapest clinical criteria.
PS-CRPS was diagnosed in 6 (8.3%), 1 (1.4%), 6 (8.3%), and 11 patients (15.3%) according to the Budapest clinical criteria, Budapest research criteria, modified Budapest criteria, and IASP criteria, respectively. The Budapest criteria and IASP criteria had sensitivities of 0.99 and 1.00, respectively, and specificities of 0.68 and 0.41, respectively, for PS-CRPS diagnosis. There were no differences in risk factors between PS-CRPS patients and non-PS-CRPS patients when the diagnosis was based on the Budapest clinical criteria. However, there were differences in muscle strength and Brunnstrom stage between PS-CRPS patients and non-PS-CRPS patients when the diagnosis was based on the IASP criteria.
Our findings indicate that the diagnostic validity of the current Budapest clinical criteria for PS-CRPS is low. Thus, the current Budapest criteria might not be appropriate for PS-CRPS diagnosis.
复杂性区域疼痛综合征-1 是一种慢性神经病理性疾病，脑卒中后复杂性区域疼痛综合征（PS-CRPS）并不罕见。目前尚缺乏应用 PS-CRPS 诊断布达佩斯标准的研究。因此，本研究旨在探讨布达佩斯标准用于 PS-CRPS 诊断的有效性，并评估脑卒中后上肢受累患者的 PS-CRPS 相关因素。
本研究纳入了 72 例首次发生导致偏瘫的脑卒中患者。根据布达佩斯临床标准诊断为 PS-CRPS 的患者中，比较布达佩斯临床标准、布达佩斯研究标准、改良布达佩斯标准（将运动/营养障碍类别的运动因素去除）和国际疼痛研究协会（IASP）标准之间 PS-CRPS 的患病率和诊断有效性。
根据布达佩斯临床标准、布达佩斯研究标准、改良布达佩斯标准和 IASP 标准，分别有 6（8.3%）例、1（1.4%）例、6（8.3%）例和 11（15.3%）例患者被诊断为 PS-CRPS。布达佩斯标准和 IASP 标准诊断 PS-CRPS 的灵敏度分别为 0.99 和 1.00，特异性分别为 0.68 和 0.41。根据布达佩斯临床标准诊断为 PS-CRPS 时，PS-CRPS 患者与非 PS-CRPS 患者的危险因素无差异。但是，根据 IASP 标准诊断时，PS-CRPS 患者与非 PS-CRPS 患者的肌肉力量和 Brunnstrom 分期存在差异。
本研究结果表明，当前布达佩斯临床标准用于 PS-CRPS 的诊断效度较低。因此，目前的布达佩斯标准可能不适合 PS-CRPS 的诊断。
