P.2.h.005 Somatic pain modulation and its role in typifying the dimension of pain in depression

Abstract

with respect to suicide risk factors in CRPS patients are available. The purpose of this study was to assess risk factors for suicidal ideation in patients with CRPS and also we evaluated psychiatric comorbidity in this population. Methods: Based on criteria established by the International Association for the Study of Pain, 39 patients diagnosed with CRPS Type 1 or Type 2 were enrolled in this study. Suicidal ideation was assessed using item 3 of the Hamilton Depression Rating Scale (HAMD). The low-suicidal ideation (SI) group included those with scores of 1 or below on HAMD item 3 (0 = suicide ideation absent, 1 = feels that life is worth living), and the high-SI group included those with HAMD item 3 scores above 1. Symptoms of pain were evaluated using the short form of the McGill Pain Questionnaire (SF-MPQ). Psychiatric symptoms were assessed in using the Structured Clinical Interview for DSM-IV Disorders (SCID-I; SCID-II), the HAMD, the Hamilton Anxiety Rating Scale (HAMA), the Global Assessment of Functioning Scale (GAF), and the Pittsburgh Sleep Quality Index (PSQI). Betweengroup comparisons involving categorical data were performed using the chi-square statistic corrected for continuity; between-group comparisons involving continuous data (age and socio-economic status) were calculated using Student’s t-test. Pearson’s correlation analysis was used to assess correlations between suicidal ideation and other variables. Results: 33 (84.6%) were diagnosed with CRPS Type 1, and six (15.4%) were diagnosed with CRPS Type II. Males accounted for 61.5% (n = 24) of the patients, and females 38.5% (n = 15). The mean age of the patients at their initial evaluation at the pain clinic was 37.87 (±11.94) years, and the mean number of years of education was 12.49 (±2.68) years. Patients reported having CRPS symptoms for a mean of 2.84 years (±2.49) at the time of evaluation and had been prescribed 4.28 (range, 0−7) different kinds of medications on average. Twenty-nine patients (74.4%) were at high risk and 10 (25.6%) were at low risk for suicidal ideation. Risk factors significantly associated with suicidal ideation included depression (p= 0.002), severity of pain (p= 0.024), and low scores on the GAF (p= 0.027). No significant correlations were found between suicidal ideation and anxiety or quality of sleep. Conclusions: CRPS is recognized as one of the most difficult conditions to treat among pain syndromes. This study found that the factors most strongly associated with suicide in patients with CRPS were depression, pain severity, and general functioning. These results suggest that psychiatric evaluation and intervention should be included in the treatment of CRPS.