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RSDSA Approves Two Research Grants for 2005
The Validation of Revised Diagnostic Criteria for CRPS
Diagnostic Criteria for CRPS has been discussed and
planned for years. Current criteria may over diagnose the
condition, and may be of limited use in guiding treatment
as their association with mechanisms believed to be involved
in producing the condition are unknown. Although earlier research
suggests the signs and symptoms of CRPS should be grouped
into four relatively independent factors, only three are currently
used in diagnosis leading to inadequate specificity and potentially,
to over diagnosis. Revised CRPS diagnostic criteria have
been proposed based on the four factors, which appear to have
a better balance of diagnostic sensitivity and specificity
than existing criteria, and this has been corroborated by
an international consensus group meeting in Budapest last
year. These proposed criteria must be validated in order for
the International Association of the Study of Pain (IASP)
to adopt them. Moreover, the validation will lead to a more
universal acceptance of the proposed changes, will encourage
adoption of these criteria for clinical diagnosis, and will
facilitate selection of more homogenous research samples.
With a research grant, R. Norman Harden, MD, Director, Center
for Pain Studies and Chronic Pain Care Center, Addison Chair,
Rehabilitation Institute of Chicago, and Stephen Bruehl, PhD,
Associate Professor of Anesthesiology at Vanderbilt University
School of Medicine, will determine the validity of proposed
diagnostic criteria using elements of a prospective correlational
design and a case comparison design, and will use a coordinated
multi-site data collection system. The sample will include
a sequential series of 120 patients meeting current IASP criteria
for CRPS and another group of 60 people with non-CRPS
neuropathic pain (eg, diabetic neuropathy) diagnosed using
independent criteria. This study will further document the
validity of these proposed diagnostic criteria by linking
them with measures reflecting pain mechanisms believed to
contribute to CRPS (e.g., central sensitization, catecholamine
activity, inflammatory changes).
Non-invasive Investigation of Human Brain Mechanisms Associated
with the Development and Treatment of CRPS will evaluate
brain mechanisms involved in CRPS and their etiological
importance. The study will use functional magnetic resonance
imaging (fMRI) and electroencephalography (EEG) to compare
brain activity, firstly in patients just after an acute injury
(wrist fracture), between patients who are at high risk of
developing CRPS to those who are at a low risk of developing
it, and secondly between those patients who do end up developing
CRPS and those who don't. The main questions are; do brain
mechanisms change before the development of CRPS? Do acute
brain changes predict CRPS? Are areas such as the thalamus,
insula and amygdala important in development of CRPS? This
study will provide a greater understanding of how the brain
is involved in CRPS, which should in turn lead to better prevention
and treatment strategies. The research team, Lorimer Moseley,
PhD, Irene Tracey, DPhil and Simon Gandevia, DSc, are undertaking
the work at Oxford University, England.
Updated July 19, 2005 |
