Epidemiology of complex regional pain syndrome in Korea: An electronic population health data study

Abstract

Chronic regional pain syndrome (CRPS) is an inflammatory and neuropathic pain disorder characterized by the involvement of the autonomic nervous system with sensory, autonomic, motor, skin, and bone changes. At present, universally accepted consensus criteria for CRPS are not yet established, despite the diagnostic criteria proposed by the International Association for the Study of Pain (IASP). Various hypotheses for the pathophysiology of CRPS have been proposed; as a result, current therapeutic modalities are varied. General epidemiological data on CRPS are necessary for effective management. However, recent data on the epidemiology of CRPS in Korea are scarce. The aim of this study was to evaluate the incidence and other epidemiological features of CRPS in the general population in Korea. In this study on the epidemiology of CRPS in Korea, population-based medical data acquired from 51,448,491 subscribers to the National Health Insurance Service (NHIS) from 2011 to 2015 were analyzed, including the incidence, distribution by the CRPS type, regional distribution, monthly distribution, medical costs, and healthcare resource-utilization. The findings indicated that the incidence of CRPS in Korea was 29.0 per 100,000 person-years in 2015 and was correlated with patient age and sex. CRPS types included type I (63%) and type II (37%); moreover, the number of individuals with CRPS I have shown a growing trend since 2011. There was no monthly distribution, but there was regional variation according to the province. The medical departments managing CRPS I the most were orthopedics, internal medicine, anesthesiology and pain medicine, in order; however, patients with CRPS spent more money per visit in the departments of rehabilitation medicine, and anesthesiology and pain medicine. The incidence rate of CRPS in Korea was 29.0 per 100,000 person-years with an increasing trend, which was correlated with patient age in the 70s and female sex. CRPS type I was more common than CRPS type II; in addition, constant increase in medical expenses, regional imbalance, and differences in medical expense among medical specialties should be considered for early management of patients to reduce the disease burden in Korea. Sharing of knowledge about the diagnostic criteria of CRPS are also needed.

Complex regional pain syndrome: a narrative review for the practising clinician

“…Utilising data from the Korean National Health Insurance Service, investigators looked at patient data from more than 74 000 patients, a much larger survey than the previous two. 5 They reported that the female to male disparity was much narrower, and the age of highest incidence was much higher than previously reported. 5 They also determined that the pelvis, thigh, and lower limb were more likely to be affected than the upper limb in their patient population.…”

“…5 They reported that the female to male disparity was much narrower, and the age of highest incidence was much higher than previously reported. 5 They also determined that the pelvis, thigh, and lower limb were more likely to be affected than the upper limb in their patient population. 5 The variability in these studies highlights the challenges of CRPS diagnosis.…”

“…6 They also showed that the upper limb was more prone to CRPS development (70% of patients), and that CRPS I occurs much more frequently than CRPS II (88% and 12%, respectively). 6 The epidemiologic survey by Kim and colleagues, 5 however, showed some important differences. Utilising data from the Korean National Health Insurance Service, investigators looked at patient data from more than 74 000 patients, a much larger survey than the previous two.…”

“…5 They also determined that the pelvis, thigh, and lower limb were more likely to be affected than the upper limb in their patient population. 5 The variability in these studies highlights the challenges of CRPS diagnosis. Because it is a clinical determination, physicians using different criteria will often have different results.…”

“…Because it is a clinical determination, physicians using different criteria will often have different results. For example in legal disability claims, many clinicians surveyed in the study be Kim and colleagues 5 utilised the Persistent Disability and Assessment Guidelines by the American Medical Association instead of the IASP or Budapest criteria. These guidelines focus more on objective findings than subjective symptoms, and older patients who are more likely to be disabled from injury may better fit the criteria, increasing the overall age of incidence.…”