General Guideline Principles for CRPS Diagnostic Criteria
for workers compensation patients

The New York State workers compensation board has developed these guidelines to help physicians, podiatrists, and other healthcare professionals provide appropriate treatment for CRPS Diagnostic Criteria.

These Workers Compensation Board guidelines are intended to assist healthcare professionals in making decisions regarding the appropriate level of care for their patients with ankle and foot disorders.

The guidelines are not a substitute for clinical judgement or professional experience. The ultimate decision regarding care must be made by the patient in consultation with his or her healthcare provider.

CRPS Diagnostic Criteria

Common traits for the diagnosis of CRPS are included in most of the reported diagnostic criteria. However, there are considerable variations in the standards for case definition. The criteria listed below might be the most popular and reliable ones.

Reflex Sympathetic Dystrophy, also known as CRPS-I, is a broad term for a painful disease that arises following a noxious event and is not restricted to the distribution of a sole peripheral nerve. The progression of the syndrome varies throughout time. In CRPS-II (also known as “Causalgia”), a particular nerve is implicated, and pain is present where the injured nerve is located.

The following conditions must be satisfied for the clinical diagnosis to be made:

1. Persistent suffering that is out of proportion to any precipitating event.

    

2. Must list at least one condition from each of the following four groups:

    

   • Sensory: Claims of allodynia or hyperesthesia

      

   • Vasomotor: Complaints of temperature asymmetry, changes in skin tone, and/or asymmetry in color.

      

   • Sudomotor/Edema: Indications of edema, alterations in sweating, or asymmetry in sweating.

      

   • Motor/Trophic: There were reports of reduced range of motion, motion dysfunction (weakness, tremor, dystonia), and/or trophic alterations (hair, nail, skin).

      

3. At least one symbol in each of the following categories must be visible at the time of evaluation:

    

   • Sensory: Hyperalgesia and/or allodynia is evident.

      

   • Asymmetry in temperature (more than 1 degree Celsius), changes in skin tone, and/or asymmetry are all signs of vasomotor function.

      

   • Sudomotor/Edema: Indications of edema, alterations in sweating, or asymmetry in sweating.

      

   • A reduced range of motion, motor dysfunction (weakness, tremor, dystonia), and/or trophic alterations (hair, nail, skin) are all examples of this.

      

4. No other explanation for the symptoms and indications is more accurate.

These criteria are advised for CRPS diagnosis but may be difficult to meet due to the need for objective measurements and tools such as infrared temperature monitors, volumetry, goniometers, and pain scales.

A fully qualified Physician (MD or DO), typically trained in such specialties as, but not typically restricted to Pain Medicine, Neurology, Physical Medicine & Rehabilitation, or Occupational Medicine, should confirm the diagnosis of CRPS for patients not meeting the criteria for a diagnosis or if CRPS whether continues or progresses.

Such a referral examination should put a special emphasis on ruling out other possible diagnoses, the presence of a temporal precipitating event, the historical information, especially from a reliable patient, objective evidence (such as a bone scan), and the presence of a recognized nerve injury (CRPS II), and comparisons with the diagnostic standards, as well as implementation.

Electrodiagnostic investigations should be carried out by the American Association of Neurological and Electrodiagnostic Medicine standards in those circumstances when they are warranted (AANEM). It is advised and desirable that doctors board-certified in neurology or manual medicine and rehabilitation conduct and interpret electrodiagnostic testing in the outpatient setting.

There should be a very low bar for concurrent psychiatric examination and consulting in these situations. Please check the medical treatment recommendations for PTSD, work-related depression, and depressive disorders.

This article offers suggestions for diagnosing and treating grown people with Complex Neural Pain Syndrome (CRPS). [Please refer to the Medical Treatment Guideline for Non-Acute Pain for diagnosing and treating non-acute pain not caused by CRPS.] Initial clinical evaluation, management, diagnostic considerations, and special studies to identify clinical pathology are some of the topics covered.

Other subjects include the initial assessment and diagnosis of patients with CRPS, identification of red flags that may indicate the presence of a serious underlying medical condition, work-relatedness, modified duty and activity, rehabilitative schemes, return to work, psychological evaluation, and behavioral issues.

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