Is there an association between psychological factors and the Complex Regional Pain Syndrome type 1 (CRPS1) in adults? A systematic review

Beerthuizen, Annemerle; van ‘t Spijker, Adriaan; Huygen, Frank J.P.M.; Klein, Jan; de Wit, Rianne

doi:10.1016/j.pain.2009.05.003

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Volume 145, Issue 1 , Pages 52-59, September 2009

Is there an association between psychological factors and the Complex Regional Pain Syndrome type 1 (CRPS1) in adults? A systematic review

Annemerle Beerthuizen
- Department of Medical Psychology and Psychotherapy, Erasmus MC, Rotterdam, The Netherlands
- Corresponding author. Address: Department of Medical Psychology and Psychotherapy, Erasmus MC, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands. Tel.: +31 10 7044234; fax: +31 10 7044695.
Adriaan van ‘t Spijker
- Department of Medical Psychology and Psychotherapy, Erasmus MC, Rotterdam, The Netherlands
Frank J.P.M. Huygen
- Department of Anesthesiology, Erasmus MC, Rotterdam, The Netherlands
Jan Klein
- Department of Anesthesiology, Erasmus MC, Rotterdam, The Netherlands
Rianne de Wit
- Department of Health Care and Nursing Science, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- University Hospital Maastricht, Maastricht, The Netherlands

Received 18 July 2008; received in revised form 20 April 2009; accepted 5 May 2009. published online 02 July 2009.

Abstract

Complex Regional Pain Syndrome type 1 (CRPS1) is a complication after trauma or surgery. Its pathophysiology is still a matter of debate, and psychological factors have been suggested to play a role, although their influence is unclear. The aim of this study was to investigate the evidence for the influence of psychological factors on the onset and maintenance of CRPS1 in adults. In a systematic review, articles were selected using Cochrane, Pubmed/Medline, Psychinfo, and Cinahl since 1980. Only original articles and empirical studies were included. Based on these selection criteria, 31 articles were identified. Studies were evaluated and weighted using a quality assessment instrument. The few prospective studies do not report a relationship between CRPS1 and depression, anxiety, neuroticism, or anger. The results of the retrospective/cross-sectional studies yield contradictory results regarding psychological problems in patients with CRPS1. A majority show no association, and studies with a higher methodological quality lean to a conclusion of no relationship between psychological factors and CRPS1. The majority of included studies (N=24; 77%) had only a poor to moderate methodological quality. Although many patients with CRPS1 are stigmatized as being psychologically different, this literature review identified no relationship between CRPS1 and several psychological factors. Only life events seemed to be associated with CRPS1: patients who experienced more life events appeared to have a greater chance of developing CRPS1. More studies with greater methodological quality and more participants should be performed on the association between psychological factors and the development and course of CRPS1.