Multicenter study on the asymmetry of skin temperature in complex regional pain syndrome

Abstract

According to the International Association for the Study of Pain (IASP) and American Medical Association (AMA), the diagnostic criteria for complex regional pain syndrome (CRPS) require the presence of skin temperature asymmetry. In CRPS, it is generally accepted that the temperature of skin of affected limbs changes from warm to cold; however, in our clinical practice, we have experienced many cases with different thermographic characteristics. Therefore, we conducted a retrospective multicenter study that examined the distribution of skin temperature in patients with CRPS and skin temperature asymmetry versus symptom duration.Patients diagnosed with type 1 or 2 CRPS were recruited. After confirming CRPS according to the IASP diagnostic criteria, infrared thermographic images were evaluated for skin temperature differences (ΔT) between the affected and unaffected limbs.A total of 296 patients with CRPS were included in this study. The median duration of symptoms was 6 months and the mean ± standard deviation of ΔT was –0.72 ± 1.65°C. A skin temperature difference between bilateral limbs (|ΔT|) of 1°C or less was seen in 131 patients (44.3%); thus, these 131 patients did not meet the IASP criteria for CRPS. Further, cool skin temperature was not observed in 88 patients (29.7%), meaning that these patients did not meet the AMA criteria for CRPS. There was no correlation between the symptom duration and ΔT (Spearman's rho = –0.075, P = 0.196) and there was no significant difference in the average ΔT among the 4 symptom duration groups (0–3 months, 4–6 months, 7–12 months, >12 months, P = 0.08).In conclusion, a considerable proportion of the patients that participated in this study did not meet the thermal criteria set forth by the IASP and AMA. Further, there was no correlation between symptom duration and skin temperature difference.

The Rodent Tibia Fracture Model: A Critical Review and Comparison With the Complex Regional Pain Syndrome Literature

“…Approximately 40–56% of CRPS patients exhibited skin temperature asymmetry in the limbs of greater than 1°C. 25, 47 In a prospective study the average temperature difference between limbs declined over the first year after the onset of CPRS, and the prevalence of skin color changes also decreased, from 95% to 45%. 9 About half of CRPS cases showed warmth and reddening of the affected skin (inflammatory phenotype) in a large multicenter study, while the remaining half had cold, bluish skin (cold phenotype).…”

Identification of complex regional pain syndrome in the upper limb: Skin temperature asymmetry after cold pressor test

“…We only studied SkTA in the upper extremity, and it is not clear whether there would be differences in SkTA found in the lower limbs, because this question has not been addressed by other authors employing mixed samples. 35 , 38 Our sample included a spectrum of symptom presentation and duration; however, others have suggested that time course was not a significant predictor of SkTA 35 ; future work should consider whether there are important patterns of symptoms (such as vasomotor changes) that influence or predict skin temperature asymmetry after cold pressor testing. We also did not distinguish between warm and cool subtypes of CRPS, 1 and it is unknown whether the baseline level of vasoconstriction or vasodilation would be an important influence on SkTA.…”

“…They reported that 44.3% of their sample did not have a skin temperature asymmetry of greater than 1°C and concluded that symptom chronicity was not an important predictor of SkTA. 35 However, it is also worth noting that their population contained more males and more persons with lower limb CRPS than upper limb CRPS and therefore may not be representative of the broader CRPS population.…”

“…However, it is important to note that the substantial confidence intervals (see Table 3 ) reflect our small sample size and the values seen here may not generalize to larger samples. The largest study of SkTA to date used thermography to examine SkTA under resting conditions in a large cohort ( n = 296) of persons with CRPS I or CRPS II 35 and reported that the mean temperature difference between affected and unaffected limbs was −0.72°C ± 1.65°C. They reported that 44.3% of their sample did not have a skin temperature asymmetry of greater than 1°C and concluded that symptom chronicity was not an important predictor of SkTA.…”

Thermovision analysis of the surface of the lower limbs in patients with symptomatic lumbosacral discopathy before and after surgery

“…2 Thermographic analysis applies in the general case of venous, arterial and lymphatic circulation disorders. 3,4 Thermography has also been used for many years in oncology as an accessory examination in the diagnosis of breast cancer 5 as a method for screening a large group of patients. 6 The effectiveness of histological, mammographic assessment in the diagnosis of early detection of breast cancer was also compared with thermographic studies, 7 as well as with USG tests.…”