Psychological Factors in Complex Regional Pain Syndrome

Abstract

Chronic pain disability is a challenging condition in which biological, psychological, and social factors dynamically interact with each other. Especially the treatment and rehabilitation of patients with CRPS put demands on techniques as well as on the rehabilitation framework. The general recommendation is a multidisciplinary team approach for CRPS patients. The psychological contribution should comprise a thorough assessment, followed by a psychological pain management component including relaxation/biofeedback training, cognitive interventions, behavioral interventions and extended cognitive-behavioral therapy.Approximately one-half to two-third of all patients diagnosed with chronic pain manifest various levels of psychological distress. Still, there is insufficient research-based information about the role of psychological factors in the etiology, prognosis and clinical picture of CRPS.Studies reveal that patients for whom CRPS-1 developed after radial forearm fracture seem to have neither a unique psychological pattern nor display more symptoms of depression than those who fully recover. In fact, CRPS patients seem to have common psychological features and show the same amount of anxiety and depression as patients with Fibromyalgia and Repetitive Strain Injury. Physical therapy in combination with autogenic relaxation training seems to lead to a significant improvement in limb temperature compared to physical therapy alone.Further research is needed to improve theory about psychological factors in CRPS. At present, there seems to be no published study specifically evaluating psychological factors in the etiology, clinical picture or prognosis of CRPS. Comparative controlled studies should be made to create practical clinical treatment methods for the patients. Probable psychological topics of importance in understanding CRPS are, among other distress factors: affect regulation and particularly alexithymia, fear-avoidance and catastrophising.