Complex regional pain syndrome type 1 in the medico-legal setting: High rates of somatoform disorders, opiate use and diagnostic uncertainty

Abstract

Objective The aim of this study was to review demographic and clinical characteristics of patients with complex regional pain syndrome type 1 (CRPS) seen in a UK medico-legal setting - particularly the relationship between CRPS and somatoform disorders. Methods Fifty consecutive cases of CRPS (interviewed 2005-2016) undergoing psychiatric assessment were reviewed. A systematic assessment of mental states was conducted via interview and examination of medical/psychiatric records. Thirty patients also completed the Brief Illness Perception Questionnaire (BIPQ). Results Sixty per cent of patients ( n = 30) were female, and the mean age was 43 years. Twenty-two per cent ( n = 11) were employed, and 60% ( n = 30) received disability benefits. Symptoms were reported in the upper limb (62%; n = 31), lower limb (30%; n = 15), both (6%; n = 3) or elsewhere (2%; n = 1). Eighty-four per cent ( n = 42) satisfied DSM-5 criteria for current somatoform disorder. A history of more than two pain-related functional somatic syndromes (e.g. non-cardiac chest pain) was found in 42% ( n = 21) and functional neurological symptoms (e.g. 'claw-hand') in 42% ( n = 21). BIPQ scores resembled those associated with somatoform disorders and disorders mediated by psychological factors (e.g. irritable bowel syndrome). In 38% ( n = 19), the CRPS diagnosis was disputed among experts. A history of depression was noted in 60% ( n = 30), panic attacks in 20% ( n = 10) and alcohol/substance misuse in 18% ( n = 9). Opiates were prescribed to 64% ( n = 32). Conclusions Patients diagnosed with CRPS involved in litigation have high rates of prior psychopathology (mainly somatoform disorders) and pain-related disability for which opiate use is common. They risk an adverse reaction to limb pain 'shaped' by maladaptive illness beliefs. The CRPS diagnosis lacks reliability in medico-legal settings and may cause iatrogenic harm.

Denying the Truth Does Not Change the Facts: A Systematic Analysis of Pseudoscientific Denial of Complex Regional Pain Syndrome

“…The reference lists of the 13 articles were screened, and 3 additional articles were found which were also screened on full-text. Of the 16 articles assessed on full-text, 9 articles were included in this review and seven articles were excluded: one article because it was written in Dutch, 4 one because it was an abstract for a conference 5 and five articles because they did not primarily focus on the claim that CRPS does not exist [6][7][8][9][10] (see Figure 1). The 9 included articles consisted of 4 narrative reviews, 2 personal views, 1 letter, 1 editorial and 1 case report (see Table 1).…”

<p>Psychiatric Comorbidity and Complex Regional Pain Syndrome Through the Lens of the Biopsychosocial Model: A Comparative Study</p>

“…Two other psychiatric diagnoses were associated with CRPS in the literature, but not found in our sample: somatoform pain disorder and dissociative or conversion disorder, also called functional neurological disorder (FND). Brinkers et al 9 found these two diagnoses, respectively, in 3% of patients who consulted in an Anesthesiology Department, 9 whereas Bass 50 found 84% of patients meeting the criteria for somatoform disorder and 42% for functional neurological symptoms compatible with conversion disorder in a medico-legal context (litigation). The prevalence of these disorders is thus highly variable and seems to depend on the clinical setting.…”

Klassifizierung von chronischen Schmerzen bei Kindern

“…Bei Kindern und Jugendlichen hingegen gehen einem CRPS häufig nur Bagatelltraumata voraus, oder die Erkrankung tritt spontan auf. Auch psychische Traumata und Substanzmissbrauch können CRPS-auslösende Faktoren sein [14]. Bei Kindern sind häufiger die distalen unteren Extremitäten betroffen.…”