PDF(Pubmed)
Abstract：
Most frequently, complex regional pain syndrome (CRPS) develops after a trauma and affects distal parts of the limbs. Early recognition and initiation of adequate treatment is crucial for a favorable outcome. On the other hand, misdiagnosing other disorders as CRPS is detrimental because more appropriate treatment may be withheld from the patients. Despite intensive research, a specific biomarker or paraclinical measure for CRPS diagnosis is still lacking. Instead, clinical criteria approved by the International Association for the Study of Pain (IASP) and latest adapted in 2019 are central for diagnosing CPRS. Thus, the CRPS diagnosis remains challenging with the risk of a \"deliberate diagnosis\" for unexplained pain, while at the same time a delayed CRPS diagnosis prevents early treatment and full recovery. CRPS is a diagnosis of exclusion. To clinically diagnose CRPS, a vigorous exclusion of \"other diseases that would better explain the signs and symptoms\" are needed before the patients should be referred to tertiary centers for specific pain treatment. We highlight red flags that suggest \"non-CRPS\" limb pain despite clinical similarity to CRPS. Clinical and neurological examination and paraclinical evaluation of a probably CRPS patient are summarized. Finally, we pinpoint common differential diagnoses for CRPS. This perspective might help CRPS researchers and caregivers to reach a correct diagnosis and choose the right treatment, regardless whether for CRPS mimics or CRPS itself.
摘要：
大多数情况下,复杂的区域性疼痛综合征（CRPS）在创伤后发展并影响四肢的远端。早期识别和开始适当的治疗对于良好的结果至关重要。另一方面,将其他疾病误诊为CRPS是有害的,因为患者可能不接受更适当的治疗。尽管进行了深入的研究,目前仍缺乏CRPS诊断的特异性生物标志物或临床旁措施.相反，国际疼痛研究协会(IASP)批准的临床标准和2019年最新修订的临床标准是诊断CPRS的核心.因此，CRPS诊断仍然具有挑战性，有可能对无法解释的疼痛进行“故意诊断”，同时延迟的CRPS诊断阻碍了早期治疗和完全康复。CRPS是一种排除性诊断。临床诊断CRPS，在将患者转诊至三级中心进行特定疼痛治疗之前，需要大力排除“其他可以更好地解释体征和症状的疾病”。尽管临床上与CRPS相似，但我们突出了提示“非CRPS”肢体疼痛的危险信号。总结了可能的CRPS患者的临床和神经系统检查和临床评估。最后,我们确定了CRPS的常见鉴别诊断。这种观点可能有助于CRPS研究人员和护理人员得出正确的诊断并选择正确的治疗方法，不管是CRPS模仿还是CRPS本身。
