Medical history and the onset of complex regional pain syndrome (CRPS)

de Mos, M.; Huygen, F.J.P.M.; Dieleman, J.P.; Koopman, J.S.H.A.; Stricker, B.H.Ch.; Sturkenboom, M.C.J.M.

doi:10.1016/j.pain.2008.07.002

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Volume 139, Issue 2 , Pages 458-466, 15 October 2008

Medical history and the onset of complex regional pain syndrome (CRPS)

M. de Mos
- Erasmus University Medical Center, Pharmaco-epidemiology Unit, Departments of Medical Informatics and Epidemiology & Biostatistics, Room 2157, Dr. Molewaterplein 50, 3015 GE, Rotterdam, The Netherlands
- Corresponding author. Tel.: +31 10 7044128; fax: +31 10 7044722.
F.J.P.M. Huygen
- Erasmus University Medical Center, Department of Pain Treatment, ‘s Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
J.P. Dieleman
- Erasmus University Medical Center, Pharmaco-epidemiology Unit, Departments of Medical Informatics and Epidemiology & Biostatistics, Room 2157, Dr. Molewaterplein 50, 3015 GE, Rotterdam, The Netherlands
J.S.H.A. Koopman
- Erasmus University Medical Center, Pharmaco-epidemiology Unit, Departments of Medical Informatics and Epidemiology & Biostatistics, Room 2157, Dr. Molewaterplein 50, 3015 GE, Rotterdam, The Netherlands
B.H.Ch. Stricker
- Erasmus University Medical Center, Pharmaco-epidemiology Unit, Departments of Medical Informatics and Epidemiology & Biostatistics, Room 2157, Dr. Molewaterplein 50, 3015 GE, Rotterdam, The Netherlands
M.C.J.M. Sturkenboom
- Erasmus University Medical Center, Pharmaco-epidemiology Unit, Departments of Medical Informatics and Epidemiology & Biostatistics, Room 2157, Dr. Molewaterplein 50, 3015 GE, Rotterdam, The Netherlands

Received 20 February 2008; received in revised form 27 May 2008; accepted 3 July 2008. published online 01 September 2008.

Abstract

Knowledge concerning the medical history prior to the onset of complex regional pain syndrome (CRPS) might provide insight into its risk factors and potential underlying disease mechanisms. To evaluate prior to CRPS medical conditions, a case–control study was conducted in the Integrated Primary Care Information (IPCI) project, a general practice (GP) database in the Netherlands. CRPS patients were identified from the records and validated through examination by the investigator (IASP criteria) or through specialist confirmation. Cases were matched to controls on age, gender and injury type. All diagnoses prior to the index date were assessed by manual review of the medical records. Some pre-specified medical conditions were studied for their association with CRPS, whereas all other diagnoses, grouped by pathogenesis, were tested in a hypothesis-generating approach. Of the identified 259 CRPS patients, 186 cases (697 controls) were included, based on validation by the investigator during a visit (102 of 134 visited patients) or on specialist confirmation (84 of 125 unvisited patients). A medical history of migraine (OR: 2.43, 95% CI: 1.18–5.02) and osteoporosis (OR: 2.44, 95% CI: 1.17–5.14) was associated with CRPS. In a recent history (1-year before CRPS), cases had more menstrual cycle-related problems (OR: 2.60, 95% CI: 1.16–5.83) and neuropathies (OR: 5.7; 95% CI: 1.8–18.7). In a sensitivity analysis, including only visited cases, asthma (OR: 3.0; 95% CI: 1.3–6.9) and CRPS were related. Psychological factors were not associated with CRPS onset. Because of the hypothesis-generating character of this study, the findings should be confirmed by other studies.

Keywords: Complex regional pain syndrome, Epidemiology, Medical history, Comorbidity, Risk factor, Pathogenesis