Acceptance of the diVerent denominations for reflex sympathetic dystrophy

Objective—To elucidate the real impact in the medical literature of the diVerent denominations for reflex sympathetic dystrophy (RSD). Methods—A search was performed through the Medline database (WinSPIRS, SilverPlatter International, NS), from 1995 to 1999, including the following descriptors: RSD, complex regional pain syndrome (CRPS), CRPS type I, algodystrophy, Sudeck, shoulder-hand syndrome, transient osteoporosis, causalgia, and CRPS type II. Results—The descriptor RSD was detected in 576 references, algodystrophy in 54, transient osteoporosis in 42, CRPS type I in 24, Sudeck in 16, and shoulderhand syndrome in 11. One hundred records were obtained for the descriptor causalgia and five for CRPS type II. The descriptor RSD was detected in the title of 262 references, algodystrophy in 29, transient osteoporosis in 29, CRPS type I in 15, Sudeck in 3, shoulder-hand syndrome in 5, causalgia in 17, and CRPS type II in 3 references. Conclusions—The new CRPS terminology has not eVectively replaced the old one. RSD and causalgia are the most used denominations. (Ann Rheum Dis 2001;60:77–79) Reflex sympathetic dystrophy (RSD) is a complex of symptoms that includes severe pain, swelling, autonomic vasomotor dysfunction, and impaired mobility of the aVected extremities. RSD has been given various names, depending on the precipitating factor, the country concerned, or the specialty treating the patient: reflex sympathetic dystrophy in English speaking, Sudeck’s atrophy in German speaking, and algodystrophy in French speaking countries; causalgia after nerve injury; postinfartion sclerodactyly by cardiologists; Pourfour du Petit syndrome by anaesthetists; and peripheral trophoneurosis or BabinskyFroment sympathetic paralysis by neurologists. Post-traumatic osteoporosis, transient osteoporosis, algoneurodystrophy, shoulderhand syndrome, gardenalic rheumatism, neurotrophic rheumatism, and reflex neurovascular dystrophy have been other terms according to diVerent countries or diVerent medical specialties. In 1994 a working group of the International Association for the Study of Pain (IASP) developed a consensus definition and proposed a new terminology. Thus the term complex regional pain syndrome (CRPS) type I replaces the name RSD, and the term CRSP type II, which requires demonstrable peripheral nerve injury, replaces the term causalgia. 4 Five years after the introduction of this new terminology we have studied its real impact in the medical literature and the terms currently used to name this syndrome. Methods We detected the reports written between 1995 and 1999 that included the following descriptors: reflex sympathetic dystrophy, complex regional pain syndrome type I, complex regional pain syndrome type 1, algodystrophy, Sudeck, shoulder-hand syndrome, transient osteoporosis, causalgia, complex regional pain syndrome type II, complex regional pain syndrome type 2, complex regional pain syndrome, and CRPS. Other descriptors were refused by none or minimal use. The search was performed through Medline database (WinSPIRS 4.01, 2000 edition, updated until June 2000, SilverPlatter International, NS). The following options were registered for every reference: title, author(s), author’s address, source, publication year, language of the article, country of publication, and medical subject heading major and minor. Results The descriptor “reflex sympathetic dystrophy” was detected in 576 references, “algodystrophy” in 54, “transient osteoporosis” in 42, “complex regional pain syndrome type I” in 24, “Sudeck” in 16, and “shoulder-hand syndrome” in 11 (table 1). One hundred records were obtained for the descriptor “causalgia” and five for the descriptor “complex regional pain syndrome type II”. Some authors used the terms “type 1 and 2” instead of “type I and II”, and records using both terminologies can be found. The descriptor “complex regional pain syndrome”, without type, detects more records than the combination of complex regional pain syndrome type I and type II (table 1); this might be caused by the trend for several authors to use the term complex regional pain syndrome merely as a synonym for RSD. The descriptor CRPS (abbreviated form and without type) was considered imprecise, because articles not related were obtained (cysteine-rich protein, C reactive protein, C receptor protein, coordinated research projects, cardiac rehabilitation programmes, collagen related peptides, etc). When we considered the presence of the diVerent terms in the title (table 1, parentheses), the descriptor “reflex sympathetic Ann Rheum Dis 2001;60:77–79 77 Division of Rheumatology, Hospital General Yagüe, Instituto Nacional de la Salud, Burgos, Spain