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Related Experiment Videos

Psychological dysfunction in patients with reflex sympathetic dystrophy

D S Ciccone1, E B Bandilla, W Wu

  • 1Department of Psychiatry, University of Medicine and Dentistry, New Jersey Medical School, Newark 07103-2714, USA.

Pain
|July 1, 1997
PubMed
Summary
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This study found reflex sympathetic dystrophy (RSD) patients are psychologically similar to those with local neuropathy, challenging non-organic theories. Back pain patients reported more diffuse symptoms and non-specific medical issues.

Area of Science:

  • Pain Medicine
  • Psychosomatic Medicine
  • Neurology

Background:

  • Reflex sympathetic dystrophy (RSD) is often characterized by pain and disability disproportionate to objective physical findings.
  • Speculation exists regarding non-organic factors mediating RSD, yet comparative studies on psychological profiles are limited.
  • Previous research has yielded inconsistent findings regarding the psychological distinctiveness of RSD patients.

Purpose of the Study:

  • To compare the psychological dysfunction patterns in patients with RSD against those with chronic back pain and local neuropathic pain.
  • To investigate the validity of the non-organic hypothesis in the etiology of RSD.
  • To assess differences in symptom reporting, illness behavior, and psychological distress across diagnostic groups.

Main Methods:

Related Experiment Videos

  • Retrospective review of 253 patients from a tertiary pain service, categorized into RSD (n=25), back pain (n=44), and local neuropathy (n=21) groups.
  • Application of stringent diagnostic criteria for RSD.
  • Analysis of covariance used to control for symptom duration and age differences; validated survey of childhood trauma administered.

Main Results:

  • No evidence suggests RSD patients are psychologically unique; they closely resemble local neuropathy patients in symptom reporting, illness behavior, and distress.
  • RSD patients reported more disability days (P < 0.05) than local neuropathy patients.
  • Back pain patients exhibited more diffuse pain complaints and non-specific medical symptoms (P < 0.05) compared to RSD and local neuropathy groups. Childhood trauma was evenly distributed across all groups.

Conclusions:

  • The findings do not support the hypothesis that RSD is primarily mediated by non-organic psychological factors.
  • RSD patients' psychological profiles are comparable to those with localized neuropathic pain, suggesting organic underpinnings.
  • The burden of proof lies with proponents of the non-organic hypothesis to provide credible evidence for psychological involvement in RSD etiology.