A prospective, multisite, international validation of the Complex Regional Pain Syndrome Severity Score

R. Norman Harden, Christian Maihofner, Elias Abousaad, Jean Jacques Vatine, Amy Kirsling, Roberto S.G.M. Perez, Maxine Kuroda, Florian Brunner, Michael Stanton-Hicks, Johan Marinus, Jacobus J. Van Hilten, Sean MacKey, Frank Birklein, Tanja Schlereth, Angela Mailis-Gagnon, Joe Graciosa, Sara B. Connoly, David Dayanim, Michael Massey, Hadas Frank & 2 others Anatoly Livshitz, Stephen Bruehl

Research output: Chapter in Book/Report/Conference proceedingChapterAcademicpeer-review

Abstract

Clinical diagnosis of complex regional pain syndrome (CRPS) is a dichotomous (yes/no) categorization, a format necessary for clinical decision making. Such dichotomous diagnostic categories do not convey an individual’s subtle gradations in the severity of the condition over time and have poor statistical power when used as an outcome measure in research. This prospective, international, multicenter study slightly modified and further evaluated the validity of the CRPS Severity Score (CSS), a continuous index of CRPS severity. Using a prospective design, medical evaluations were conducted in 156 patients with CRPS to compare changes over time in CSS scores between patients initiating a new treatment program and patients on stable treatment regimens. New vs stable categorizations were supported by greater changes in pain and function in the former. Results indicated that CSS values in the stableCRPStreatment group exhibited much less change over time relative to the new treatment group, with intraclass correlations nearly twice as large in the former. A calculated smallest real difference value revealed that a change in the CSS of$4.9 scale points would indicate real differences in CRPS symptomatology (with 95% confidence). Across groups, larger changes in CRPSfeatures on the CSS over time were associated in the expected direction with greater changes in pain intensity, fatigue, social functioning, ability to engage in physical roles, and general well-being. The overall pattern of findings further supports the validity of the CSS as a measure of CRPS severity and suggests it may prove useful in clinical monitoring and outcomes research.
Original languageEnglish
Title of host publicationPain
PublisherLippincott Williams and Wilkins
Pages1430-1436
Number of pages7
ISBN (Print)0000000000000
DOIs
Publication statusPublished - 1 Aug 2017

Publication series

NamePain
Volume158

Cite this

Norman Harden, R., Maihofner, C., Abousaad, E., Vatine, J. J., Kirsling, A., Perez, R. S. G. M., ... Bruehl, S. (2017). A prospective, multisite, international validation of the Complex Regional Pain Syndrome Severity Score. In Pain (pp. 1430-1436). (Pain; Vol. 158). Lippincott Williams and Wilkins. https://doi.org/10.1097/j.pain.0000000000000927
Norman Harden, R. ; Maihofner, Christian ; Abousaad, Elias ; Vatine, Jean Jacques ; Kirsling, Amy ; Perez, Roberto S.G.M. ; Kuroda, Maxine ; Brunner, Florian ; Stanton-Hicks, Michael ; Marinus, Johan ; Van Hilten, Jacobus J. ; MacKey, Sean ; Birklein, Frank ; Schlereth, Tanja ; Mailis-Gagnon, Angela ; Graciosa, Joe ; Connoly, Sara B. ; Dayanim, David ; Massey, Michael ; Frank, Hadas ; Livshitz, Anatoly ; Bruehl, Stephen. / A prospective, multisite, international validation of the Complex Regional Pain Syndrome Severity Score. Pain. Lippincott Williams and Wilkins, 2017. pp. 1430-1436 (Pain).
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abstract = "Clinical diagnosis of complex regional pain syndrome (CRPS) is a dichotomous (yes/no) categorization, a format necessary for clinical decision making. Such dichotomous diagnostic categories do not convey an individual’s subtle gradations in the severity of the condition over time and have poor statistical power when used as an outcome measure in research. This prospective, international, multicenter study slightly modified and further evaluated the validity of the CRPS Severity Score (CSS), a continuous index of CRPS severity. Using a prospective design, medical evaluations were conducted in 156 patients with CRPS to compare changes over time in CSS scores between patients initiating a new treatment program and patients on stable treatment regimens. New vs stable categorizations were supported by greater changes in pain and function in the former. Results indicated that CSS values in the stableCRPStreatment group exhibited much less change over time relative to the new treatment group, with intraclass correlations nearly twice as large in the former. A calculated smallest real difference value revealed that a change in the CSS of$4.9 scale points would indicate real differences in CRPS symptomatology (with 95{\%} confidence). Across groups, larger changes in CRPSfeatures on the CSS over time were associated in the expected direction with greater changes in pain intensity, fatigue, social functioning, ability to engage in physical roles, and general well-being. The overall pattern of findings further supports the validity of the CSS as a measure of CRPS severity and suggests it may prove useful in clinical monitoring and outcomes research.",
keywords = "CRPS Severity Score, Complex regional pain syndrome, Prospective, Reflex sympathetic dystrophy, Severity, Validation",
author = "{Norman Harden}, R. and Christian Maihofner and Elias Abousaad and Vatine, {Jean Jacques} and Amy Kirsling and Perez, {Roberto S.G.M.} and Maxine Kuroda and Florian Brunner and Michael Stanton-Hicks and Johan Marinus and {Van Hilten}, {Jacobus J.} and Sean MacKey and Frank Birklein and Tanja Schlereth and Angela Mailis-Gagnon and Joe Graciosa and Connoly, {Sara B.} and David Dayanim and Michael Massey and Hadas Frank and Anatoly Livshitz and Stephen Bruehl",
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Norman Harden, R, Maihofner, C, Abousaad, E, Vatine, JJ, Kirsling, A, Perez, RSGM, Kuroda, M, Brunner, F, Stanton-Hicks, M, Marinus, J, Van Hilten, JJ, MacKey, S, Birklein, F, Schlereth, T, Mailis-Gagnon, A, Graciosa, J, Connoly, SB, Dayanim, D, Massey, M, Frank, H, Livshitz, A & Bruehl, S 2017, A prospective, multisite, international validation of the Complex Regional Pain Syndrome Severity Score. in Pain. Pain, vol. 158, Lippincott Williams and Wilkins, pp. 1430-1436. https://doi.org/10.1097/j.pain.0000000000000927

A prospective, multisite, international validation of the Complex Regional Pain Syndrome Severity Score. / Norman Harden, R.; Maihofner, Christian; Abousaad, Elias; Vatine, Jean Jacques; Kirsling, Amy; Perez, Roberto S.G.M.; Kuroda, Maxine; Brunner, Florian; Stanton-Hicks, Michael; Marinus, Johan; Van Hilten, Jacobus J.; MacKey, Sean; Birklein, Frank; Schlereth, Tanja; Mailis-Gagnon, Angela; Graciosa, Joe; Connoly, Sara B.; Dayanim, David; Massey, Michael; Frank, Hadas; Livshitz, Anatoly; Bruehl, Stephen.

Pain. Lippincott Williams and Wilkins, 2017. p. 1430-1436 (Pain; Vol. 158).

Research output: Chapter in Book/Report/Conference proceedingChapterAcademicpeer-review

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AU - Perez, Roberto S.G.M.

AU - Kuroda, Maxine

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AU - Marinus, Johan

AU - Van Hilten, Jacobus J.

AU - MacKey, Sean

AU - Birklein, Frank

AU - Schlereth, Tanja

AU - Mailis-Gagnon, Angela

AU - Graciosa, Joe

AU - Connoly, Sara B.

AU - Dayanim, David

AU - Massey, Michael

AU - Frank, Hadas

AU - Livshitz, Anatoly

AU - Bruehl, Stephen

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AB - Clinical diagnosis of complex regional pain syndrome (CRPS) is a dichotomous (yes/no) categorization, a format necessary for clinical decision making. Such dichotomous diagnostic categories do not convey an individual’s subtle gradations in the severity of the condition over time and have poor statistical power when used as an outcome measure in research. This prospective, international, multicenter study slightly modified and further evaluated the validity of the CRPS Severity Score (CSS), a continuous index of CRPS severity. Using a prospective design, medical evaluations were conducted in 156 patients with CRPS to compare changes over time in CSS scores between patients initiating a new treatment program and patients on stable treatment regimens. New vs stable categorizations were supported by greater changes in pain and function in the former. Results indicated that CSS values in the stableCRPStreatment group exhibited much less change over time relative to the new treatment group, with intraclass correlations nearly twice as large in the former. A calculated smallest real difference value revealed that a change in the CSS of$4.9 scale points would indicate real differences in CRPS symptomatology (with 95% confidence). Across groups, larger changes in CRPSfeatures on the CSS over time were associated in the expected direction with greater changes in pain intensity, fatigue, social functioning, ability to engage in physical roles, and general well-being. The overall pattern of findings further supports the validity of the CSS as a measure of CRPS severity and suggests it may prove useful in clinical monitoring and outcomes research.

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Norman Harden R, Maihofner C, Abousaad E, Vatine JJ, Kirsling A, Perez RSGM et al. A prospective, multisite, international validation of the Complex Regional Pain Syndrome Severity Score. In Pain. Lippincott Williams and Wilkins. 2017. p. 1430-1436. (Pain). https://doi.org/10.1097/j.pain.0000000000000927