Background: Complex regional pain syndrome is a painful and disabling post‐traumatic primary pain disorder. Acute and chronic complex regional pain syndrome (CRPS) are major clinical challenges. In Europe, progress is hampered by significant heterogeneity in clinical practice. We sought to establish standards for the diagnosis and management of CRPS.Methods: The European Pain Federation established a pan‐European task force of experts in CRPS who followed a four‐stage consensus challenge process to produce mandatory quality standards worded as grammatically imperative (must‐do) statements.Results: We developed 17 standards in 8 areas of care. There are 2 standards in diagnosis, 1 in multidisciplinary care, 1 in assessment, 3 for care pathways, 1 in information and education, 4 in pain management, 3 in physical rehabilitation and 2 on distress management. The standards are presented and summarized, and their generation and consequences were discussed. Also presented are domains of practice for which no agreement on a standard could be reached. Areas of research needed to improve the validity and uptake of these standards are discussed.Conclusion: The European Pain Federation task force present 17 standards of the diagnosis and management of CRPS for use in Europe. These are considered achievable for most countries and aspirational for a minority of countries depending on their healthcare resource and structures.Significance: This position statement summarizes expert opinion on acceptable standards for CRPS care in Europe.

The paper presents the results of a prospective trial to examine the natural history of early reflex sympathetic dystrophy (RSD). Thirty patients with post-traumatic RSD of the hand were observed without treatment. They were reassessed 1, 2 and 6 months after diagnosis with a final assessment at 10 to 18 months (average 13 months). Twenty-seven patients completed the study. Three were withdrawn during the study because of persistence of signs and symptoms of RSD and were given further treatment. Of the 27 patients who completed the study, only one showed sufficient features of the condition to warrant the diagnosis of mild RSD. In the remaining 26, most features of RSD had resolved spontaneously. Pain and swelling disappeared more quickly than other features of RSD. Although the signs and symptoms of RSD had largely gone at 13 months, the hands were still functionally impaired because of weaker grip strength.

A prospective study was designed to investigate the question “Do patients who develop Complex Regional Pain Syndrome Type 1 (CRPS Type 1) after fracture of the distal radius display different psychological behaviour patterns and/or are more depressive than those who recover uneventfully after this fracture?” Sixty-two patients of mean age 56 years with displaced distal radius fractures were operated on by closed reduction and percutaneous fixation with K-wires. All these patients were examined psychologically on the day after the operation. A series of standardized, self-administered questionnaires was used to assess personality and depression. Fifty of the 62 patients were reassessed at 2 months for symptoms and signs of CRPS Type 1 and a diagnosis of this condition made on clinical grounds. Nine patients (18%) were diagnosed as having CRPS Type 1. There were no significant differences in scores on any of the personality and depression scales between CRPS Type 1 and non-CRPS Type 1 patients. Therefore, patients who eventually developed CRPS Type 1 after radial forearm fracture had neither a unique psychological pattern nor displayed more symptoms of depression than those who recovered uneventfully.

This study investigated the effect on the power and function of the hand of loss of finger(s) extension, number of fingers involved and the patient’s age in Dupuytren’s disease and the influence of improvement of finger extension and the patient’s age on these variables after surgery. Median values at presentation included total loss of extension 80° total grip strength 41 kg and DASH score 54. Twelve months postoperatively, the median value of total loss of extension decreased to 10°and the DASH score to 32 (both significant improvements). Grip strength decreased slightly to 40 kg. The severity of the contracture had no significant effect on function but had a significant negative effect on power. The number of fingers involved affected neither function nor power. The age of the patient did not influence function of the hand. However, older patients experienced less functional benefit from surgery. The improvement of finger extension following surgery had significant beneficial effect on function, but no effect on power.

Quantitative analysis of three-phase bone scintigrams was done in 70 patients with reflex sympathetic dystrophy (RSD) and in 30 patients who did not have RSD after injury to the hand or wrist. Regions of interest were selected and the uptake ratios (affected/unaffected) were calculated. Significant differences between affected and unaffected patients were seen in the metacarpal area in phase 2 of the scintigrams as well as in the metacarpophalangeal joints and metacarpal bones in phase 3. Combination of these images had the greatest diagnostic value. Sensitivity and specificity of 80% were achieved in the regions of interest in phase 3. The duration of RSD and the predisposing injury significantly affected the results of bone scintigraphy. It was also noted that a fracture may cause increased fixation of the tracer in each phase of three-phase bone scintigraphy in asymptomatic patients.