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
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