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<span class="label l-pain">Pain Medicine</span>
<h1 class="h1">Diagnosing Long-Standing CRPS: A Summary of New ASIPP Guidance</h1>
<p class="byline">By Ivan Urits, MD - Board Certified in Anesthesiology and Pain Medicine<span class="pd">Published Oct 6, 2026</span></p>
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<p>Complex regional pain syndrome (CRPS) is a painful and often disabling condition, most often in a limb after an injury or surgery. Doctors usually diagnose it with the Budapest criteria. A guidance document from the American Society of Interventional Pain Physicians (ASIPP), published in <em>Pain Physician</em>, looks at a practical problem: how to recognize CRPS once it has lasted a long time.</p>
<p>This summary is based on the published abstract; the full paper may include additional detail. Read the abstract on PubMed: <a href="https://pubmed.ncbi.nlm.nih.gov/40773629/" rel="noopener">https://pubmed.ncbi.nlm.nih.gov/40773629/</a></p>
<h2>What was studied</h2>
<p>The authors describe CRPS as causing intense pain, swelling, changes in skin color and temperature, motor problems, and trophic changes such as skin and tissue atrophy. Its exact cause is not fully understood.</p>
<p>They point out a gap. There are no established diagnostic criteria for chronic CRPS, and the Budapest criteria do not clearly separate the acute and chronic stages.</p>
<h2>How it was done</h2>
<p>An expert panel convened by ASIPP reviewed the literature and used a structured consensus process. Because the features of CRPS change significantly beyond 12 months, the panel drafted chronic-specific criteria based on how long the disease has lasted, the history, the physical exam, and optional tests. The drafts were refined with multidisciplinary input.</p>
<h2>Key findings</h2>
<p>The proposed framework for chronic CRPS has four parts:</p>
<ul>
<li><strong>General criteria:</strong> the Budapest criteria are met for at least 12 months, CRPS remains a diagnosis of exclusion, and it is distinguished from generalized nociplastic pain syndromes.</li>
<li><strong>History:</strong> at least three of five specific historical features.</li>
<li><strong>Examination:</strong> asymmetric limb findings, sensory disturbances, and musculoskeletal changes.</li>
<li><strong>Optional testing:</strong> such as intraepidermal nerve fiber density on skin biopsy and imaging evidence of regional bone demineralization.</li>
</ul>
<p>The authors add that quantitative sensory testing, functional MRI, and blood markers of neuroinflammation may support the diagnosis in complex or uncertain cases. For treatment, they emphasize a multimodal approach: physical rehabilitation, medicines for neuropathic pain, sympathetic nerve blocks, and advanced neuromodulation, tailored to the disease stage and the patient.</p>
<h2>Limitations</h2>
<ul>
<li>This is consensus guidance, not a new clinical study. The criteria rest on expert agreement and the existing literature.</li>
<li>The chronic criteria are newly proposed. The abstract does not report testing of how accurate they are in patients.</li>
<li>Some optional tests may not be widely available.</li>
</ul>
<h2>Safety takeaways</h2>
<ul>
<li>The Budapest criteria remain the foundation. The new framework builds on them rather than replacing them.</li>
<li>CRPS is a diagnosis of exclusion. Other causes of the symptoms should be considered, especially when pain has lasted a long time.</li>
<li>Duration matters. CRPS can change over time, so a careful history and exam are important at each stage.</li>
<li>Clear records help. Noting which criteria are met, and when, supports clear communication across the care team.</li>
<li>Care should be individualized, usually combining rehabilitation with other treatments.</li>
</ul>
</div>
<h2>Reference</h2>
<ol class="refs">
<li>Gharibo C, Day M, Aydin SM, Kaye AD, Abdi S, Diwan S, et al. Diagnostic Guidance for Chronic Complex Regional Pain Syndrome Type I and Type II from The American Society of Interventional Physicians (ASIPP). Pain Physician. 2025;28(4):E287-E327. PMID: 40773629. Abstract: <a href="https://pubmed.ncbi.nlm.nih.gov/40773629/" rel="noopener">https://pubmed.ncbi.nlm.nih.gov/40773629/</a></li>
</ol>
<p class="rel"><strong>Related:</strong> <a href="/crps-expert-witness">CRPS Expert Witness Cases</a></p>
<p class="fine">This article is educational information, not legal or medical advice.</p>
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