What is the incidence of complex regional pain syndrome (CRPS) Type I within four months of a wrist fracture in the adult population? A systematic review

Abstract

Introduction Complex regional pain syndrome (CRPS) is a severe chronic pain condition, the symptoms of which may develop following trauma to a limb. Despite wrist fracture being a common antecedent, estimates of the incidence of CRPS following this injury vary widely. Our objective was to establish the incidence of CRPS in adults within four months of a wrist fracture, using a systematic review of the literature published since 2010. Methods The databases MEDLINE, PubMed, EMBASE, PsychINFO, CINAHL, BNI and AMED were searched for observational studies reporting the incidence of CRPS following a wrist fracture. Inclusion criteria were the use of a validated diagnostic tool to assess for CRPS within four months of the fracture. Randomised controlled trials and clinical trials were excluded, as were data from patients with evidence of prior neurology. Incidence risk was then extracted or calculated. Included studies were assessed for methodological rigour using the Newcastle–Ottowa Scale for assessment of bias. Results Nine studies met the inclusion criteria. There was a high degree of heterogeneity in study populations including study setting, fracture management and diagnostic criteria. From the three studies with the highest methodological rigour we determined that the incidence risk of CRPS in adults is between 3.7% and 14% using the Budapest criteria, with an observation of lower rates in conservatively managed fractures. Discussion We found evidence that the reported incidence of CRPS is influenced by choice of diagnostic criteria, along with the study location and/or how the fracture is managed.

Healthcare Costs, Time to Fitness for Work, and Related Factors in Chronic Complex Regional Pain Syndrome: A Comparative and Longitudinal Study of 5-Year Follow-Up

“…33 For healthcare costs (non-normally distributed variable), we applied a logarithmic link, then a gaussian function in the models. For model selection, we tested the quasi-likelihood under the quasiinformation criterion (QIC) with different variance structures: exchangeable, autoregressive AR(1) or AR (2). 34 The AR (2) was chosen because it had the smallest QIC among different variance structures.…”

“…1 CRPS of the hand is the most frequent, and its incidence is estimated at 3.7% to 14% after wrist fracture. 2 Patients with CRPS have longer disability, 3 lower quality of life, 4 and higher economic and social burden than reference patients. 1 According to a recent study using the Swiss National Accident Insurance database, the healthcare costs and number of days lost at work were 13 and 20 times higher, respectively, in patients with CPRS over the 5 years after the accident 1 than in patients without CRPS.…”

Prognostic factors for persistent pain after a distal radius fracture: a systematic review

“…Complex Regional Pain Syndrome has been found to have an incidence of between 3.7% and 14% after a wrist fracture. 6 It is therefore possible that some of the patients identified in the papers reporting on persistent pain had CRPS, and as such, it is unsurprising that there may be some crossover between the risk factors reported for persistent pain and CRPS in this review.…”

“…Proposed mechanisms of chronic secondary pain following a fracture include mechanical factors such as mal-or non-union of the fracture and neuropathic pain such as carpal tunnel syndrome. The debilitating primary chronic pain condition Complex Regional Pain Syndrome (CRPS) has been found to occur in 3.7–14% of patients within 12 weeks of a wrist fracture, 6 and can persist for at least 2 years from time of onset. 7 Chronic hand and wrist pain can impact on the patient’s quality of life, return to work and resumption of usual activities.…”