Investigate the Effect of Psychological Factors in Development of Complex Regional Pain Syndrome Type I in Patients with Fracture of the Distal Radius: A Prospective Study

Abstract

Background: To investigate the role of psychological factors (anxiety and depression) and pain measured on a visual analogue scale (VAS) in the development of complex regional pain syndrome type I (CRPS I) following the distal radius fracture (DRF). Methods: A consecutive sample of patients (N=60) with a distal radius fracture was measured for signs of CRPS by Budapest criteria weekly till 8 weeks and then another follow-up one year after injury to determine the incidence and predictors of developing CRPS I in a prospective cohort study and also to discover whether there is difference between pain, depression, and anxiety level in the patients with and without CRPS I. The most of the patients were treated by Pin stabilization. The Beck depression inventoryshort form (BDI), State-Trait Anxiety Inventory, and Numerical pain rating scale were used to determine the patients’ psychological features and pain intensity at the base line and 8 weeks after the fracture. Results: CRPS I developed in 15 (25%) patients after eight weeks and just last in 10 (16.67%) patients after one year. No difference was found between the two groups (CRPS and non-CRPS group) in terms of state (STAI-I) and trait (STAI-II) anxiety, and BDI score. Pain at the base line was the most important risk factor in developing CRPS (odds ratio [OR] =1.52; 95% CI). Conclusions: After fracturing the distal radius, patients who have high pain intensity have a higher risk of developing CRPS I. To following these patients closely for the development of CRPS I may be advantageous for early preventative and therapeutic interventions.

What is the incidence of complex regional pain syndrome (CRPS) Type I within four months of a wrist fracture in the adult population? A systematic review

“…9,[27][28][29] One study used the 1993 Veldman diagnostic criteria, 30 two used the 1994 IASP diagnostic criteria 28,31 and five used the Budapest criteria. 9,15,27,29,32,33 Moseley et al used the criteria as recommended by Harden et al, 17 as these became the Budapest criteria we grouped these together. Within those using the Budapest criteria, four used the research criteria 9,29,32,33 and two used the clinical criteria.…”

“…9,15,27,29,32,33 Moseley et al used the criteria as recommended by Harden et al, 17 as these became the Budapest criteria we grouped these together. Within those using the Budapest criteria, four used the research criteria 9,29,32,33 and two used the clinical criteria. 15,27 Seven of the nine studies were conducted in hospital fracture clinics/recruited from the emergency department 9,15,[27][28][29]31,33 and two were conducted in rehabilitation units, 30,32 on patients referred by orthopaedic surgeons.…”

“…Within those using the Budapest criteria, four used the research criteria 9,29,32,33 and two used the clinical criteria. 15,27 Seven of the nine studies were conducted in hospital fracture clinics/recruited from the emergency department 9,15,[27][28][29]31,33 and two were conducted in rehabilitation units, 30,32 on patients referred by orthopaedic surgeons. The studies originated from at least eight different countries with one article not explicitly stipulating the study location.…”

“…9,15 Studies that included only surgically managed, 27 or only conservatively managed 29,30,33 patients were considered to have a selection bias as they did not encompass the whole wrist fracture population; therefore the impact of the fracture management strategy on the population incidence of CRPS was unknown. Two studies that recruited patients referred for rehabilitation post wrist fracture 30,32 were also considered to have a selection bias. It is the authors' experience that, as patients with a more complex fracture or exhibiting early signs of CRPS are more likely to be referred to physiotherapy, this would present a significant source of bias.…”

Complex regional pain syndrome: an evolving perspective

“…As mentioned in the earlier section, patients with a high level of pain at the time of injury have been shown to be more at risk of developing CRPS 1. 38 It would appear that the suppression of pain is of great importance in the early stage of the condition.…”