CRPS/RSD and Psychological Factors

It is a terribly under-appreciated fact that CRPS mounts a tremendous assault on our psyches and emotions; some (including myself) feel that this aspect is at least as important as its disastrous physical consequences. The sense of uniqueness, isolation, and despair is known to us all, but is seldom discussed by even the best pain management physicians.

That's why many feel that obtaining independent psychological support is an essential part of CRPS treatment. The purpose of this page is to facilitate that quest and to provide some scientific information about what is currently known of the psychological effects of CRPS.

In addition to the specific articles listed below, you should know that there are three peer-reviewed, high-impact journals concerning neuropsychology that are all open access; i.e., all content is free. Even if you're not too technically inclined, it's interesting to see the available articles and to take a try reading any that look interesting. I suspect you'll find it easier going than you think. The journals are (these links open in new tabs/windows): "Psychopharmacology", "Neuropsychopharmacology", and "Neuropsychopharmacology Reviews". We should all be most grateful to the forward-looking American College of Neuropsychopharmacology for making these journals available at no cost to the public at large.

Title (& link)
Description
62 Signs And Symptoms Of Depression And Anxiety In Men & Women "Depression and anxiety come in diverse forms and affect many people differently. Depression is a state when someone feels depressed, hopeless and apathetic in everyday life."
63 tips for dealing with depression alone naturally without drugs The top 63 tips for dealing with depression alone naturally without drugs or pills. I also provide you with a collection of articles related to depression."
Anxiety and Depression Are Associated With Migraine and Pain in General: An Investigation of the Interrelationships
"Anxiety and depression are consistently associated with pain, regardless of anatomical site. These disorders may be important factors in the co-occurrence of different pain disorders"
Anxious personality is a risk factor for developing complex regional pain syndrome type I
"Following anxious patients closely for the development of CRPS type I may be advantageous for early preventative and therapeutic interventions "
The association between psychological factors and the development of CRPS1 – A prospective multi-center study
"No empirical evidence supports a diagnosis of CRPS1 patients as psychologically different, and the current results indicate that there is no association between psychological factors and CRPS1"
Biopsychosocial complexity is correlated with psychiatric comorbidity but not with perceived pain in complex regional pain syndrome type 1 (algodystrophy) of the knee
"Unlike with other pain syndromes, with CRPS the intensity of the perceived pain did not vary with biopsychosocial complexity." This theme is seen again and again in such studies.
Coping with chronic complex regional pain syndrome: advice from patients for patients
"Our study provides support both for the argument put forward by Redman that without appropriate preparation and support, self-management is ineffective"
A large study showing that those with CRPS showed no psychological patterns different from those who did not develop it.
Cyberhugs: Creating a Voice for Chronic Pain Sufferers Through Technology
"This article explores the need for a safe and secure place for chronic pain sufferers to talk of their pain experiences."
Functional (psychogenic) movement disorders: merging mind and brain
Explores the association between psych. factors involved in movement disorders.
Is there an association between psychological factors and the Complex Regional Pain Syndrome type 1 (CRPS1) in adults? A systematic review
"Only life events seemed to be associated with CRPS1: patients who experienced more life events appeared to have a greater chance of developing CRPS1."
Mind/body connection: learning how to improve emotional health "Emotions, which are freely expressed and experienced without attachment or judgment, tend to flow fluidly. In contrast, repressed emotions can zap hope and mental energy."
Modern pathophysiological research is showing an appreciation of the importance of both physical and psych. factors in FMD.
"Modern pathophysiological research is showing an appreciation of the importance of both physical and psychological factors in FMD."
A Motivational Therapeutic Assessment Improves Pain, Mood, and Relationship Satisfaction in Couples With Chronic Pain
"The results provide preliminary evidence for the short-term benefits of a brief motivational assessment to improve psychosocial functioning in both patients and spouses"
Prospective examination of pain-related and psychological predictors of CRPS-like phenomena following total knee arthroplasty: a preliminary study
"There appears to be a modest utility for preoperative distress and pain in predicting CRPS signs and symptoms following TKA, although false positive rates are relatively high."
Psychologic Factors in the Development of Complex Regional Pain Syndrome: History, Myth, and Evidence
Points out that although CRPS patients do not have an associated psych. profile, these factors affect patients' ability to cope.
Psychological Aspects of Neuropathic Pain
An early article, pointing out the need for additional studies on the association between psychology and neuropathic pain.
Psychological and Behavioral Aspects of Complex Regional Pain Syndrome Management
"The psychological component of treatment can work synergistically with medical and physical/occupational therapies to improve function and increase patients’ ability to manage the condition successfully"
Psychological factors: anxiety, depression, and somatization symptoms in low back pain patients
"Psychological distress such as anxiety, depression, and somatization were more prevalent in LBP patients compared to patients without LBP"
Psychological Features of Patients with Complex Regional Pain Syndrome Type I Related Dystonia
"Although the psychological profile of the patients with CRPS-I-related dystonia shows some elevations, there does not seem to be a unique disturbed psychological profile on a group level."
Psychological Screening/Phenotyping as Predictors for Spinal Cord Stimulation
A good summary of why psych. screening is an important part of determining good candidates for SCS therapy.
Similarities Between the Psychological Profiles of Complex Regional Pain Syndrome and Conversion Disorder Patients
A paper illustrating that patients with CRPS or conversion disorder have similar psych. profiles.
The Essential Guide to Sleep Hygiene A truly excellent resource for anyone having sleep problems, which includes pretty much all CRPS patients!

Suicide

We all know the sense of isolation, fear, misunderstanding by others (even those close to us), despair, and sense of hopelessness that so often is part of CRPS/RSD. It not only follows that CRPS patients might be at higher risk for suicide than other chronic illnesses; this is borne out by research. With the unrelenting, incomprehensible pain of CRPS, its other horrible physical, emotional, and psychological destruction, it's not surprising that more CRPS patients commit suicide than those with any other illness (I saw this statistic awhile back, and am still trying to find its source. I'll post it as soon as it's located). I often say, only somewhat in jest, that one of the most awful aspects of CRPS is that it doesn't even have the decency to be fatal.

I won't dwell on this terrible effect of our illness, but it is a reality, and I want to at least provide a few links to sources of help. If you or a patient you know feel you've reached the end of your rope with RSD, don't really want to end your life, but are starting to think it may be your only escape from your current misery, there is much compassionate help available. Please check out at least a few of these resources; as always, the gold stars represent my own view of its value:

17 Non-Profits Dedicated to Parents, Students, and Teachers a carefully edited collection of web sites that are very useful to the three populations mentioned in the title.

​​22 Empowering Life Lessons for Kids "These lessons not only help us to be better people, but they also help us to make friends, have long lasting relationships, and be kind to others."

Beyond Antidepressants: Taking Stock of New Treatments "reviews a bevy of emergent treatments including new medications, electrical and magnetic stimulation of the brain, and long-term cognitive behavioral therapy for stress management."

Depression and Suicide "Talking About Treatment/Getting Treatment for Clinical Depression/Various Discussions - Why We Don't Get Treatment, Social Stigma"

​​​Find Local Mental Health Services a very fast clearinghouse for finding a therapist (or any other specialty, for that matter) anywhere in the U.S. Just enter the specialty

gold starHandling a Call from a Suicidal Person we can never tell when we might be suddenly thrust into this position without warning, and this is a great, practical list of what to do. Put it by your phone.

gold stargold stargold starIf You Are Thinking About Suicide....Read This First the best page of its kind that I've yet seen.

National Suicide Prevention Lifeline "The National Suicide Prevention Lifeline is a 24-hour, toll-free, confidential suicide prevention hotline available to anyone in suicidal crisis or emotional distress."

Parent's Guide to Teen Depression "this website has grown from a small local project to an internationally recognized resource serving over 60 million people a year."

gold starSuicidal.com "When No One Knows Your Pain - A Place of Hope & Compassion for the Depressed & Suicidal".

Suicide Hotlines a wonderful site, with many specific phone numbers and other useful links.

Suicide.org "Suicide Prevention, Suicide Awareness, Suicide Support".

Teachers Training Guide - School Mental Health "This guide has been pulled together to provide teachers and educators with an overview of the most common mental illnesses and disorders."

gold stargold starWarning Signs "Recognize the Signs Of Possible Suicide Risk" - an excellent list of signs that someone is considering suicide. If you're like me, some of them wouldn't have occurred to you.

Recent Referreed Journal Articles Concerning Suicide Related to Chronic Pain

Assessing Suicide Risk in Patients with Chronic Pain and Depression

Change in Suicidal Ideation After Interdisciplinary Treatment of Chronic Pain

Perceived Burdensomeness and Suicide-Related Behaviors in Clinical Samples: Current Evidence and Future Directions

Practical considerations and patient selection for intrathecal drug delivery in the management of chronic pain

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