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Validation of proposed diagnostic criteria (the “Budapest Criteria”) for Complex Regional Pain Syndrome

Harden, Norman R.a,*; Bruehl, Stephenb; Perez, Roberto S.G.M.c,d; Birklein, Franke; Marinus, Johand,f; Maihofner, Christiang; Lubenow, Timothyh; Buvanendran, Asokumarh; Mackey, Seani; Graciosa, Josepha; Mogilevski, Milaa; Ramsden, Christophera; Chont, Melissab; Vatine, Jean-Jacquesj

doi: 10.1016/j.pain.2010.04.030

Current IASP diagnostic criteria for CRPS have low specificity, potentially leading to overdiagnosis. This validation study compared current IASP diagnostic criteria for CRPS to proposed new diagnostic criteria (the “Budapest Criteria”) regarding diagnostic accuracy. Structured evaluations of CRPS-related signs and symptoms were conducted in 113 CRPS-I and 47 non-CRPS neuropathic pain patients. Discriminating between diagnostic groups based on presence of signs or symptoms meeting IASP criteria showed high diagnostic sensitivity (1.00), but poor specificity (0.41), replicating prior work. In comparison, the Budapest clinical criteria retained the exceptional sensitivity of the IASP criteria (0.99), but greatly improved upon the specificity (0.68). As designed, the Budapest research criteria resulted in the highest specificity (0.79), again replicating prior work. Analyses indicated that inclusion of four distinct CRPS components in the Budapest Criteria contributed to enhanced specificity. Overall, results corroborate the validity of the Budapest Criteria and suggest they improve upon existing IASP diagnostic criteria for CRPS.

a Rehabilitation Institute of Chicago, Chicago, IL, USA

b Vanderbilt University School of Medicine, Nashville, TN, USA

c VU University Medical Center, Amsterdam, The Netherlands

d Trauma Related Neuronal Dysfunction Consortium (TREND), Leiden University Medical Center, Leiden, The Netherlands

e University Medical Center Mainz, Mainz, Germany

f Leiden University Medical Center, Leiden, The Netherlands

g University of Erlangen-Nuremberg, Erlangen, Germany

h Rush University Medical Center, Chicago, IL, USA

i Stanford University Medical Center, Stanford, CA, USA

j Reuth Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

*Corresponding author. Address: Center for Pain Studies, Rehabilitation Institute of Chicago, 446 E. Ontario, Suite 1011, Chicago, IL 60611, USA. Tel.: +1 312 238 7878; fax: +1 312 238 7624.

E-mail addresses:,

Submitted November 18, 2009; revised March 19, 2010; accepted April 20, 2010.

© 2010 Lippincott Williams & Wilkins, Inc.
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