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Validity of the Budapest Criteria For Poststroke Complex Regional Pain Syndrome

Oh, Sang-Wook MD*; Choi, Seong-Uk MD*; Park, Mina MD*; Shin, Joon-Ho MD, MS*,†

doi: 10.1097/AJP.0000000000000741
Original Articles
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Objectives: Complex regional pain syndrome-1 is a chronic neuropathic disorder, and poststroke complex regional pain syndrome (PS-CRPS) is not a rare complication. There is a lack of study implementing the Budapest criteria for PS-CRPS diagnosis. Thus, the present study investigated the validity of the Budapest criteria for PS-CRPS diagnosis and assessed the PS-CRPS–related factors in stroke patients with an affected upper extremity.

Methods: The study included 72 patients with first-ever stroke resulting in hemiplegia. The prevalence of PS-CRPS and diagnostic validity were compared among the Budapest clinical criteria, Budapest research criteria, modified Budapest criteria (removal of the motor factor from the motor/trophic category), and International Association for the Study of Pain (IASP) criteria in patients diagnosed with PS-CRPS according to the Budapest clinical criteria.

Results: PS-CRPS was diagnosed in 6 (8.3%), 1 (1.4%), 6 (8.3%), and 11 patients (15.3%) according to the Budapest clinical criteria, Budapest research criteria, modified Budapest criteria, and IASP criteria, respectively. The Budapest criteria and IASP criteria had sensitivities of 0.99 and 1.00, respectively, and specificities of 0.68 and 0.41, respectively, for PS-CRPS diagnosis. There were no differences in risk factors between PS-CRPS patients and non–PS-CRPS patients when the diagnosis was based on the Budapest clinical criteria. However, there were differences in muscle strength and Brunnstrom stage between PS-CRPS patients and non–PS-CRPS patients when the diagnosis was based on the IASP criteria.

Discussion: Our findings indicate that the diagnostic validity of the current Budapest clinical criteria for PS-CRPS is low. Thus, the current Budapest criteria might not be appropriate for PS-CRPS diagnosis.

Departments of *Rehabilitation Medicine

Neurorehabilitation, National Rehabilitation Center, Seoul, Republic of Korea

The authors declare no conflict of interest.

Reprints: Joon-Ho Shin, MD, MS, Department of Rehabilitation Medicine, National Rehabilitation Center, 58, Samgaksan-ro, Gangbuk-gu, Seoul 01022, Republic of Korea (e-mail: asfreelyas@gmail.com).

Received January 17, 2019

Accepted June 17, 2019

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