Psychiatric Disorders in Complex Regional Pain Syndrome (CRPS): The Role of the Consultation-Liaison Psychiatrist

Table 1

IASP criteria for the diagnosis of CRPS before and after 2010.

IASP diagnostic criteria for complex regional pain syndrome (CRPS) up to 2010 [9]	IASP diagnostic criteria for complex regional pain syndrome (CRPS) after 2010 [8]
(1) The presence of an initiating noxious event, or a cause of immobilization^†	(1) Continuing pain, which is disproportionate to any inciting event
(2) Continuing pain, allodynia, or hyperalgesia in which the pain is disproportionate to any known inciting event	(2) Must report at least one symptom in three of the four following categories:
	Sensory: reports of hyperalgesia and/or allodynia
	Vasomotor: reports of temperature asymmetry and/or skin color changes and/or skin color asymmetry. Sudomotor/edema: reports of edema and/or sweating changes and/or sweating asymmetry. Motor/trophic: reports of decreased range of motion and/or motor dysfunction (weakness, tremor, dystonia) and/or trophic changes (hair, nails, skin)
(3) Evidence at some time of edema, changes in skin blood flow, or abnormal sudomotor activity in the region of pain (can be sign or symptom)	(3) Must display at least one sign^# at the time of evaluation in two or more of the following categories: Sensory: evidence of hyperalgesia (to pinprick) and/or allodynia (to light touch and/or deep somatic pressure and/or joint movement)
	Vasomotor: evidence of temperature asymmetry and/or skin color changes and/or asymmetry. Sudomotor/edema: evidence of edema and/or sweating changes and/or sweating asymmetry. Motor/trophic: evidence of decreased range of motion and/or motor dysfunction (weakness, tremor, dystonia) and/or trophic changes (hair, nails, skin)
(4) This diagnosis is excluded by the existence of other conditions that would otherwise account for the degree of pain and dysfunction	(4) There is no other diagnosis that better explains the signs and symptoms

^∗If seen without “major nerve damage,” diagnose CRPS I; if seen in the presence of “major nerve damage,” diagnose CRPS II. ^#A sign is counted only if it is observed at the time of diagnosis. ^†Not required for diagnosis; 5–10% of patients will not have this.