The Warm Phase of CRPS Type-1: Is It Time to Review the Budapest Criteria?

Journal and index pages often block iframe embedding. This reader keeps the evidence details in Orthonotes and leaves the source page one click away.

Abstract

Conflict of interest statement: The authors declare no conflicts of interest. 5. Curr Pain Headache Rep. 2018 Feb 1;22(1):7. doi: 10.1007/s11916-018-0659-7. Utility of Radionuclide Bone Scintigraphy in Complex Regional Pain Syndrome. Howard BA(1), Roy L(2), Kaye AD(3), Pyati S(4)(5). Author information: (1)Division of Nuclear Medicine, Department of Radiology, Duke University Medical Center, Durham, NC, 27710, USA. (2)Department of Anesthesiology, Duke University Medical Center, Durham, NC, 27710, USA. (3)Department of Anesthesiology, Louisiana State University, New Orleans, LA, 70112, USA. (4)Department of Anesthesiology, Duke University Medical Center, Durham, NC, 27710, USA. Srinivas.pyati@duke.edu. (5)Department of Anesthesiology, Durham Veterans Affairs Medical Center, Durham, NC, 27710, USA. Srinivas.pyati@duke.edu. PURPOSE OF REVIEW: To describe the current understanding of the role of three-phase bone scintigraphy (TPBS) in the diagnosis and management of complex regional pain syndrome (CRPS), discuss its advantages and limitations, and present three examples of TPBS patterns typically seen in CRPS patients. RECENT FINDINGS: CRPS is a debilitating disorder frequently presenting with pain to ordinarily non-painful stimuli, redness, swelling, following fractures, stroke, myocardial infarction, surgery, or even minor trauma, and its diagnosis, based on clinical criteria and supportive imaging findings, is difficult. Of the available adjunctive diagnostic imaging modalities, radionuclide bone scintigraphy using a TPBS protocol is the most sensitive and specific for detecting abnormalities commonly seen with this condition-classically, increased periarticular uptake on delayed phase of TPBS, with variable increased uptake on perfusion phases, depending on chronicity. Recent studies have (1) demonstrated a more heterogeneous correlation of TPBS findings with CRPS diagnosis using the current Budapest criteria than in studies using older criteria, (2) pointed to the utility of novel quantitative scintigraphic techniques, and (3) highlighted the value of the early perfusion phases of TPBS in predicting treatment response. TPBS remains a valuable imaging adjunct to clinical diagnosis of CRPS. In combination with a multi-modal analgesic approach, TPBS can be used to follow disease course and potentially treatment response, although prospective trials are needed to further delineate its role. DOI: 10.1007/s11916-018-0659-7