Poor prognostic factors in complex regional pain syndrome 1: a Delphi survey.

OBJECTIVE A major challenge in the management of patients with complex regional pain syndrome 1 is identifying those individuals who are at risk of developing severe problems. Data from large follow-up studies providing empirical evidence are largely lacking. The goal of this study was to obtain an expert-agreed priority list of parameters that are correlated with a poor prognosis. METHODS In a two-round Delphi survey, experts were asked to list those parameters that they considered to be strongly associated with a poor prognosis (first round) and to weight parameters that they believed to be most relevant for poor prognosis (second round). Median ratings and interquartile ranges were calculated. Rates > 7 and interquartile ranges < 3 depicted important and expert-agreed parameters. RESULTS Thirty-nine experts compiled a list of 254 items. Twenty-eight experts reached a consensus on 49 important items associated with poor prognosis. They primarily agreed on clinical manifestations of complex regional pain syndrome 1. Psychosocial factors were considered less important. CONCLUSION The findings of this study indicate that poor prognosis for complex regional pain syndrome 1 is primarily dependent on clinical manifestations. While evidence suggests that psychosocial factors may play a role in the development of the condition, their role in poor prognosis appears to be less important.