Budapest Criteria for CRPS
International Association for the Study of Pain (IASP) — Clinical Diagnostic Criteria
Complex Regional Pain Syndrome (CRPS) is diagnosed using the Budapest Criteria, the current international standard. A diagnosis requires meeting all four of the criteria listed below. There is no single laboratory test for CRPS — the diagnosis is based on your clinical history and examination findings.
1
Continuing Pain
You experience ongoing pain that is disproportionate to the severity of any initial injury or inciting event.
2
Symptom History
You must report at least one symptom in three of the four categories below:
≥ 1 symptom in ≥ 3 categories| Category | Reported Symptoms |
|---|---|
|
Sensory
|
Increased sensitivity to pain (hyperalgesia) and/or pain from stimuli that normally don't cause pain (allodynia), such as light touch |
|
Vasomotor
|
Temperature differences between the affected and unaffected limb, and/or skin color changes (redness, blue/purple discoloration, or mottling) |
|
Sudomotor / Edema
|
Swelling (edema) of the affected area and/or changes in sweating patterns (increased or decreased sweating compared to the other side) |
|
Motor / Trophic
|
Decreased range of motion, weakness, tremor, or other movement difficulty; and/or changes in hair growth, nail growth, or skin texture |
3
Signs on Examination
At the time of evaluation, your doctor must observe at least one sign in two or more of the following categories:
≥ 1 sign in ≥ 2 categories| Category | Observed Signs |
|---|---|
|
Sensory
|
Evidence of hyperalgesia (to pinprick) and/or allodynia (to light touch, temperature, deep pressure, or joint movement) |
|
Vasomotor
|
Measurable temperature asymmetry (greater than 1 °C) and/or visible skin color changes or asymmetry |
|
Sudomotor / Edema
|
Visible edema and/or observable sweating changes or asymmetry between limbs |
|
Motor / Trophic
|
Demonstrable decreased range of motion, motor dysfunction (weakness, tremor, dystonia), and/or trophic changes (hair, nails, skin) |
4
No Better Explanation
No other medical diagnosis better accounts for the signs and symptoms. Your doctor will rule out other conditions — such as infections, vascular disorders, or nerve injuries — before confirming a CRPS diagnosis.
Understanding the Difference: Symptoms vs. Signs
Symptoms are what you experience and report to your doctor (e.g., "my hand feels swollen and burns"). Signs are what your doctor can directly observe or measure during the examination (e.g., visible swelling, measurable temperature difference). The Budapest Criteria require both — your reported experience and objective findings on exam.