Proposed New Diagnostic Criteria for Complex Regional Pain Syndrome

Dear Dr. Toda, Our manuscript in Pain Medicine[1] is a topical review, or a summary of the statistical derivation of criteria published in two articles in 1999 [2,3], and the complete corroboration and codification of these proposed criteria by consensus at a closed Workshop in Budapest in the fall of 2003 (published in 2005; [4]). Although details of how the signs and symptoms were derived are not presented in the topical review [1] they are mentioned in some detail in the original publications [2,3]. Specifically temperature difference was defined as “a detectable difference in temperature of the affected vs unaffected side by the dorsum of the examiners hand”. This was done, specifically, so that the criteria could be acquired “at the bedside” without any special equipment. It is “common knowledge” that this sort of manual examination can detect approximately a 1°C or greater difference, as any physical examination book will corroborate. To our knowledge no one has formally studied this medical lore, but work in our lab suggests this is accurate. However, it is important to note that this clinical examination maneuver can be substantially improved if some type of thermography test is performed (temperature tape, thermistor, infrared thermometer: all inexpensive). The best objective measure corroborate the exam is quantitative infrared telethermography in which average and point temperatures can be objectively assessed and documented.