Controversies surrounding reflex sympathetic dystrophy: A review article

Abstract

The topic of reflex sympathetic dystrophy (RSD) has generated an increasingly significant volume of medical literature and controversy over the last decade. A search of PubMed, the online site of the National Library of Medicine, for papers on RSD reveals nearly 2200 articles on the topic (using algodystrophy as the search word, wherein RSD references are also included, and more older and European articles are also listed). From 1991 through 1998 inclusive there is an average of nearly 100 articles per year on the topic, which represents more than a third of all the articles referenced since 1965. In the decade of the 1980s, there is an average of 64 articles per year, 74 per year in the last half of the decade and 54 per year in the first half. Prior to the decade of the 1980s, one finds an average of 40 articles per year back to the mid-1960s. The controversy surrounding the disorder centers around the nature of the problem and whether it is a primary organic disorder or a primary psychogenic disorder associated with the accomplishment of some secondary gain. If it is the former, then clearly research should continue to determine the nature and etiology of the malfunctioning organ(s). If, on the other hand, RSD is a psychogenic disorder, then the medical community does well to focus mainly on the peripheral manifestations of the problem. In that instance, therapy should be primarily psychological and cognitive with regard to the secondary gain, and persistent organic treatments are unlikely to improve the condition in general and worsen individual cases.

Anxious personality is a risk factor for developing complex regional pain syndrome type I

“…In this study, 13 of the 50 (26%) patients with a fracture of the distal radius, who were treated conservatively by closed reduction and cast immobilization, developed CRPS type I. Several reviews, including case studies, and a small number of studies on the relationship between psychological factors and CRPS type I have been published, but the literature on this issue is mixed [17,19,[34][35][36][37][38]. Some retrospective studies demonstrated that emotional, behavioral, and personality abnormalities are prominent in CRPS type I patients [16,19,39,40].…”

“…Several reviews, including case studies, and a small number of studies on the relationship between psychological factors and CRPS type I have been published, but the literature on this issue is mixed [17,19,[34][35][36][37][38]. Some retrospective studies demonstrated that emotional, behavioral, and personality abnormalities are prominent in CRPS type I patients [16,19,39,40]. Pollack et al [19] proposed Sudeck A type personality, which is characterized by emotional imbalance, increased anxiety, decreased self confidence, tendency for depression, and somatization, and suggested that these personality traits predispose an individual to CRPS type I development.…”

“…Some retrospective studies demonstrated that emotional, behavioral, and personality abnormalities are prominent in CRPS type I patients [16,19,39,40]. Pollack et al [19] proposed Sudeck A type personality, which is characterized by emotional imbalance, increased anxiety, decreased self confidence, tendency for depression, and somatization, and suggested that these personality traits predispose an individual to CRPS type I development. On the other hand, personality disorders and major depression are observed at similar frequencies in CRPS type I and other chronic pain syndromes, such as low back pain and local neuropathy [7,41,42].…”

“…Two retrospective studies reported that people with a history of psychiatric disorders are more prone to developing CRPS type I than others [19,23]. On the other hand, Dijkstra et al [8] concluded in their prospective study that past psychiatric history has no effect on CRPS development.…”

“…Psychological factors are also an area of interest due to the observation that some CRPS type I patients present with enigmatic features and emotional and behavioral characteristics. Some studies have shown that emotional imbalance, anxiety, somatization, tendency for depression, and a lack of confidence are prominent features in patients with CRPS type I. CRPS type I has been hypothesized to be psychosomatic in origin, and some special psychological features predispose an individual to developing CRPS type I and accelerate progression [19][20][21][22][23]. Many authors have advised that treatment of the disease must include psychological support and treatment [23][24][25].…”