Abstract
Complex regional pain syndrome (CRPS) is a distressing and difficult-to-treat complication
of wrist fracture. Estimates of the incidence of CRPS after wrist fracture vary greatly.
It is not currently possible to identify who will go on to develop CRPS after wrist
fracture. In this prospective cohort study, a nearly consecutive sample of 1,549 patients
presenting with wrist fracture to 1 of 3 hospital-based fracture clinics and managed
nonsurgically was assessed within 1 week of fracture and followed up 4 months later.
Established criteria were used to diagnose CRPS. The incidence of CRPS in the 4 months
after wrist fracture was 3.8% (95% confidence interval = 2.9–4.8%). A prediction model
based on 4 clinical assessments (pain, reaction time, dysynchiria, and swelling) discriminated
well between patients who would and would not subsequently develop CRPS (c index .99). A simple assessment of pain intensity (0–10 numerical rating scale) provided
nearly the same level of discrimination (c index .98). One in 26 patients develops CRPS within 4 months of nonsurgically managed
wrist fracture. A pain score of ≥5 in the first week after fracture should be considered
a “red flag” for CRPS.
Perspective
This study shows that excessive baseline pain in the week after wrist fracture greatly
elevates the risk of developing CRPS. Clinicians can consider a rating of greater
than 5/10 to the question “What is your average pain over the last 2 days?” to be
a “red flag” for CRPS.
Key words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The Journal of PainAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Dysynchiria: Watching the mirror image of the unaffected limb elicits pain on the affected side.Neurology. 2005; 65: 751-753
- Features of algodystrophy after Colles' fracture.J Bone Joint Surg Br. 1990; 72: 105-110
- Using the bootstrap to improve estimation and confidence intervals for regression coefficients selected using backwards variable elimination.Stat Med. 2008; 27: 3286-3300
- Bootstrap methods for developing predictive models.Am Stat. 2004; 58: 131-137
- Colles' fracture: A study of 2000 cases from the New York State Workmen's Compensation Board.J Bone Joint Surg. 1953; 35A: 643-658
- External validation of IASP diagnostic criteria for complex regional pain syndrome and proposed research diagnostic criteria. International Association for the Study of Pain.Pain. 1999; 81: 147-154
- Does evidence support physiotherapy management of adult Complex Regional Pain Syndrome Type One? A systematic review.Eur J Pain. 2009; 13: 339-353
- The incidence of complex regional pain syndrome: A population-based study.Pain. 2007; 129: 12-20
- Medical history and the onset of complex regional pain syndrome (CRPS).Pain. 2008; 139: 458-466
- Outcome of the complex regional pain syndrome.Clin J Pain. 2009; 25: 590-597
- Risk factors for complex regional pain syndrome in patients with traumatic extremity injury.Ulusal Travma Ve Acil Cerrahi Derg. 2010; 16: 144-148
- Incidence of complex regional pain syndrome type I after fractures of the distal radius.Eur J Pain. 2003; 7: 457-462
- Fracture of the distal radius including sequelae—shoulder-hand-finger syndrome, disturbance in the distal radio-ulnar joint and impairment of nerve function. A clinical and experimental study.Acta Orthop Scand. 1967; : 103+
- Clinical Epidemiology: Principles, Methods and Applications for Clinical Research.Jones & Bartlett, Sudbury, MA2009
- Multivariate prognostic models: Issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors.Stat Med. 1996; 15: 361-387
- Goodness of fit tests for the multiple logistic regression model.Commun Stat Theor Methods. 1980; 9: 1043-1069
- Nerve entrapment and reflex sympathetic dystrophy after fractures of the distal radius.Scand J Plast Reconstr Surg Hand Surg. 1995; 29: 53-58
- The impact of chronic pain on life in the household.J Pain Symptom Manage. 2002; 23: 433-441
- Multiple imputation: Current perspectives.Stat Methods Med Res. 2007; 16: 199-218
- Clinical features and pathophysiology of complex regional pain syndrome—Current state of the art.Lancet Neurol. 2011; 10: 637-648
- Classification of Chronic Pain.IASP Press, Seattle, WA1994
- Why do people with complex regional pain syndrome take longer to recognize their affected hand?.Neurology. 2004; 62: 2182-2186
- Evidence based guidelines for complex regional pain syndrome type 1.BMC Neurol. 2010; 10: 20
- The Pain Catastrophizing Scale: Development and validation.Psychol Assess. 1995; 7: 524-532
- Theoretical perspectives on the relation between catastrophizing and pain.Clin J Pain. 2001; 17: 52-64
- Complex regional pain syndrome (type 1): A comparison of 2 diagnostic criteria methods.Clin J Pain. 2008; 24: 637-640
- Cultural components in responses to pain.J Soc Issues. 1952; 8: 16-30
- Can vitamin C prevent complex regional pain syndrome in patients with wrist fractures?.J Bone Joint Surg Am. 2007; 89A: 1424-1431
- Effect of vitamin C on frequency of reflex sympathetic dystrophy in wrist fractures: A randomised trial.Lancet. 1999; 354: 2025-2028
References
- Dysynchiria: Watching the mirror image of the unaffected limb elicits pain on the affected side.Neurology. 2005; 65: 751-753
- Dysynchiria is not a common feature of neuropathic pain.Eur J Pain. 2008; 12: 128-131
- The Pain Catastrophizing Scale: Development and validation.Psychol Assess. 1995; 7: 524-532
Article info
Publication history
Published online: November 21, 2013
Accepted:
August 17,
2013
Received in revised form:
July 8,
2013
Received:
April 20,
2013
Footnotes
G.L.M. is supported by and receives project funding from the National Health & Medical Research Council of Australia (IDs 571090, 630431, 63136, and 100817). R.D.H. is supported by and receives project funding from the National Health & Medical Research Council of Australia (IDs 1020622, 1055084). J.J.V.H. and J.M. participate in TREND, a Dutch knowledge consortium funded by The Netherlands' Ministry of Economic Affairs (BSIK03016). This study also was supported by Nuffield Dominions Trust, RSD Society of America.
The authors have no conflicts of interest to declare.
Identification
Copyright
© 2014 American Pain Society. Published by Elsevier Inc. All rights reserved.
