Kemler et al used a combination of criteria for the diagnosis of reflex sympathetic dystrophy (RSD). The authors are from Maastricht University in the Netherlands.


Diagnosis of reflex sympathetic dystrophy requires:

(1) all 4 absolute criteria

(2) 3 or more of the relative criteria


Absolute criteria:

(1) pain

(2) impaired function

(3) symptoms beyond the area of trauma

(4) cold, warm, or intermittently cold and warm feeling in the affected area



• Criteria 2 and 3 are not included in the criteria of the International Association for the Study of Pain (IASP).


Relative criteria:

(1) edema

(2) increased nail growth

(3) increased hair growth

(4) hyperhidrosis

(5) abnormal skin color

(6) hypoesthesia

(7) hyperalgesia

(8) mechanical or thermal allodynia or both

(9) patchy demineralization of bone



• hyperhydrosis = increased perspiration

• hypooesthesia = decreased sensitivity

• hyperalgesia = excessive sensitivity to pain

• allodynia = a painful response to a stimulus that would normally be non-noxious.


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