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

Abstract

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.

Post-traumatic complex regional pain syndrome: clinical features and epidemiology

“…Highest peak of incidence was reported after 3 months from trauma (20). In contrast with the general opinion of literature about CRPS incidence (0.9-51%) (17,18,21,22), the lower percentage in the present study demonstrates again how the lacking of a gold standard in diagnosis and different rate of specificity criteria influence the correct selection of CRPS cases.…”

“…Beerthuizen et al investigated the incidence of CRPS I in different fracture types and the prevalence of the disease after trauma (20). A large cohort of 596 patients, recruited from the emergency room with a single fracture of the ankle or scaphoid or wrist or metatarsal V was enrolled and followed for 1 year.…”

Baseline Pain Intensity Is a Predictor of Chronic Pain in Individuals With Distal Radius Fracture

“…A recent publication summarized that the incidence of CRPS observed in previous research was estimated to be 1% to 37% following DRF. 4 The authors reported that the incidence of CRPS was 14% following DRF. 4 In our study, a total of 30% of individuals were found to have chronic pain (score of 13 or greater on pain subscale) at 1 year.…”

“…4 The authors reported that the incidence of CRPS was 14% following DRF. 4 In our study, a total of 30% of individuals were found to have chronic pain (score of 13 or greater on pain subscale) at 1 year. Our purpose was to use baseline pain intensity to predict chronic pain following DRF irrespective of whether the pain was related to CRPS.…”

The role of peripheral nerve injections in the diagnosis and treatment of CRPS

“…It is well accepted that high levels of pain in the early phases of trauma is strongly related to higher incidence of CRPS, suggesting a central sensitization as a background for the disease [16,21,22]. Female gender can be considered a risk factor for CRPS [15,[18][19][20][23][24][25][26] and, since there is a higher incidence in older patients, the postmenopausal status is also related higher incidence of CRPS [14][15][16]21], although this association could be an epiphenomena linked to higher incidence of fractures and others traumas in this population.…”