Complex Regional Pain syndrome (CRPS) of Budapest
Definition A persistent pain syndrome which is disproportionate to any inciting event. It results from partial peripheral nerve damage. This syndrome is characterized by a constellation of symptoms divided in four categories: sensory, vasomotor, sudomotor and motor/trophic. The term “Complex Regional Pain Syndrome” (CRPS) and its diagnostic criteria were established by the Budapest Consensus Meeting (1999).
A bit of history In 1999, after three days of deliberation in Budapest, 38 international experts established criteria combining symptoms (reported) and clinical examination findings (observed or even measured) across four categories. This consensus, which demonstrated high inter-rater reliability, laid the groundwork for comparative research aimed at generating practice-based evidence for this syndrome, which is NOT incurable.
Clinical Presentation and Mechanisms CRPS can affect six regions (in order of frequency): foot (47%), hand (35%), knee (10%), shoulder (5%), elbow (2%), and hip (1%) (Chapdelaine & Spicher, 2020). Symptoms may include:
Intra-articular sensations of: a) burning, boiling, like a volcano. b) fluctuating stiffness worsened by mobilisation of the affected joint;
Hypersensitivity that persists after touch. In only 70% of our cohort (n=476 patients), slight partial hypoesthesia was covered by an allodynic territory;
A change in skin “color” and “swelling” of the affected joint.
Psychosocial Impact Constant pain, often misunderstood, leads to isolation, anxiety and disrupts the therapeutic dialogue. Sleep is severely disrupted: restless nights and frequent awakenings exacerbate exhaustion and pain. The erroneous label of the syndrome as being “incurable” reinforces this distress.
Treatment through alternating co-therapy Guiding the patient toward a new future involves placing them at the center of their treatment: 1). sleep management (power naps, ultradian cycles, etc.), 2). limiting movements that exacerbate sensations of burning/heat/cold/ice, 3). re-sensitizing slight hypoesthesias, 4). protecting any areas that are hypersensitive to touch.
In summary, CRPS of Budapest is a multidimensional and potentially reversible syndrome. Its diagnosis is based on specific criteria. Appropriate management, focused on neuropathic pain, opens up new therapeutic possibilities and a path toward recovery.
