What are the CRPS Budapest Criteria?

Last week a new client contacted me. During our discussion, she asked if I could explain to her what were the Budapest Criteria, as her pain specialist had mentioned them, but she had not really understood their significance to her condition.

There are currently no medical tests for Complex Regional Pain Syndrome (CRPS), a clinical diagnosis being based entirely upon an accepted set of guidelines. At their conference in 2004, the International Association for the Study of Pain (IASP) adopted a new set of guidelines for diagnosing CRPS, superseding guidelines which had been in place for the previous decade. As the conference took place in Budapest, the new guidelines were named the Budapest Criteria.

Signs and Symptoms

The Budapest Criteria differentiates between ‘signs’, which are seen or felt by the person carrying out the examination and ‘symptoms’ which are reported by the patient.

Under the Budapest Criteria, for a diagnosis of CRPS, a patient must have at least one symptom in three of the following four categories:

Sensory: hyperaesthesia (an abnormal increase in sensitivity) and/or allodynia (pain caused by usually non-painful stimuli);
Vasomotor: skin colour changes or temperature and/or skin colour changes between the limbs;
Sudomotor/oedema: oedema (swelling) and/or sweating changes and/or sweating differences between the limbs.
Motor/trophic: decreased range of motion and/or motor dysfunction (weakness, tremor, muscular spasm (dystonia)) and/or trophic changes (changes to the hair and/or nail and/or skin on the limb).

At the time of clinical examination, at least one sign must be present in two or more of the following categories:

Sensory: hyperalgesia (to pinprick) and/or allodynia (to light touch and/or deep somatic (physical) pressure and/or joint movement);
Vasomotor: temperature differences between the limb and/or skin colour changes and/or skin colour changes between the limb;
Sudomotor/oedema: oedema and/or sweating changes and/or sweating differences between the limbs;
Motor/trophic: decreased range of motion and/or motor dysfunction (ie weakness, tremor or muscle spasm) and/or trophic changes (hair and/or nail and/or skin changes).

Finally, it is important that no other diagnosis can explain the signs and symptoms.

Whilst diagnosis is fundamental if appropriate treatment is to be obtained, a common diagnostic problem is that not all symptoms and signs are always present at the same time.