We use the quantitative sensory testing (QST) following the protocol of DFNS (German Research Network on Neuropathic Pain), using both thermal and mechanical nociceptive as well as non-nociceptive Stimuli. (Quantitative sensory testing in the German Research Network on Neuropathic Pain (DFNS): standardized protocol and reference values. Rolke R et al.Pain. 2006 Aug;123(3):231-43)

Hi Claude

The International Association for the Study of Pain (IASP) defined the criteria for Complex Regional Pain Syndrome.

It defined sensory abnormalities from a clinical examination:

•     Sensory Symptoms reported by the patient:

1. Hyperesthesia or 2. allodynia

1.       Hyperesthesia(the increased non-painful sensation to a non-painful stimuli)

2.       Allodynia (increased painful sensation to a non-painful stimuli)

• Sensory Findings on clinical examination:

1. Hyperesthesia or 2. allodynia

1.     hyperalgesia (a mild painful stimuli, as a pinprick, triggers disproportionately increased or severe pain)

2.       allodynia (a non-painful stimuli, such as light touch, temperature stimuli, pressure, or joint movement, trigger pain)

3.       Hyperpathy (a mild painful stimuli provokes a disproportionately increased or severe pain…some accept that the there is a long lasting sensation of remnant pain as the clinical manifestation of increased threshold to a repetitive stimuli)

If you prefer more standardized ways to measure it, you could check one of the following questionnaires that have reported validity and reliability:

CPQ: Chronic Pain Grade

Von Korff M, Ormel J, Keefe FJ, Dworkin SF. Grading the severity of chronic pain. Pain. 1992;50(2):133–149

DN4: Douleur Neuropathique 4

Bouhassira D, Attal N, Alchaar H. Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4). Pain. 2005;114(1–2):29–3

NPQ_SF: Neuropathic Pain Questionnaire Short Form

NPQ_LF: Neuropathic Pain Questionnaire Long Form

Krause SJ, Backonja MM. Development of a neuropathic pain questionnaire. Clin J Pain. 2003;19(5):306–314

Brush Allodynia

van Eijs F, Smits H, Geurts JW, Kessels AG, Kemler MA, van Kleef M, Joosten EA, Faber CG. Brush-evoked allodynia predicts outcome of spinal cord stimulation in complex regional pain syndrome type 1. Eur J Pain 2010;14:164–169

Neuropath. Pain Q

Krause SJ, Backonja MM. Development of a neuropathic pain questionnaire. Clin J Pain 2003;19:306–314.

NPS: Neuropathic Pain Scale

Galer BS, Jensen MP. Development and preliminary validation of a pain measure specifi c to neuropathic pain: the neuropathic pain scale. Neurology. 1997;48(2):332–338

TReND symptom inventory

Collins S, van Hilten JJ, Marinus J, Zuurmond WW, de Lange JJ, Perez RS. Development of a symptoms questionnaire for complex regional pain syndrome and potentially related illnesses: the Trauma Related Neuronal Dysfunction Symptoms Inventory. Arch Phys Med Rehabil 2008;89:1114–1120.

I hope it helps if your question is related to a clinical way to assess the sensory findings.

Yours, 

Mario

The above information answers your question.  You may need to distinguish CRPS Types I & II as well.  As you know, Type I includes SMP (sympathetically maintained pain, previously known as Reflex Sympathetic Dystrophy) in addition to chronic pain with somatosensory symptoms (CRPS II), & as such includes autonomic changes producing symptoms & signs.  Autonomic dysregulation (sympathetic overactivity) may result in edema, diaphoresis, other vasomotor instability with skin color changes (such as livedo reticularis), at the affected area.  In addition then to the above somatosensory changes that are measured subjectively using patient symptoms & examiners physical findings, ancillary tests can be performed to measure autonomic dysfxn (thermographic findings of skin temperature changes, sudomotor function testing, trophic changes evident on bone scan or plain X-ray).  The latter tests have not been evaluated as to sensitivity, specificity, predictive value as of the 2009 publication of Pain Management Secrets, 3rd Ed by Charles E. Argoff, MD & Gary McClean, MD by Mosby Elsevier.  You may find this book useful.

Thank you very much indeed. Your informations are very valuable. However in CRPS (Budapest criteria - Harden et al., 2007) we are supposed to consider 4 categories of SYMPTOMS. The first one is named: Somatosensory. The description of its symptom - described by the patient -  is: "hyperaesthesia". With my 27-year of experience, as clinician, I nerver heard a patient describing its symptom as an "Hyperaesthesia". They are complaining about "painful to touch" - "tender" - "sensibilile al tocco" - "sensivel em tocare" - "aiguisé" - "überemplinflich", etc. Are all these terms a positive symptom of "Hyperaesthesia" or not ? How do you personnaly manage your question to your patient ?

An open-ended question of what they are feeling, which would then fit in a category of hypoesthesia (decreased sensation to pain or other stimulus), hyperesthesia (increased sensation to pain or other stimulus), allodynia (non-painful stimulus produces pain), anesthesia (loss of any sensation/numbness), analgesia (loss of pain sensation), paresthesia (any abnormal sensation, such as pins & needles), dysesthesia (painful paresthesia), formication (sensation of bugs crawling on body), anesthesia dolorosa (pain in area that is desensitized/anesthetic area), etc, depending upon their description (the clinician needs to translate, which may introduce some bias)...if the patient has trouble describing, I try to make the distinctions for them, to which they may reply.  Hope this information is more helpful.

Thank you everybody for your contributions.When I am reading the ex ellent article by Harden et al. Validation of proposed diagnostic criteria ("Budapest") for CRPS. Pain 2010,  90.2 % are suffering of the symptom : "Hyperaesthesia".  The clinical examination sign of this hyperaesthesia are Allodynia 70.5 %; Hyperalgesia 81.5 & Hypoaesthesia to light touch 57 %. I am wondering when patient are complaining about "Hyperaesthesia" about which somatosensory SYMPTOM are they complaining about?