CRPS shares with all chronic pain states the problems inherent in a condition that adversely affects the individual's own psyche and self-image, role in the family, work status, financial status, and involvement in the legal system. It is apparent that CRPS does not have any predictable psychological precursor,66 but equally apparent is that it produces severe psychological adverse effects. These are not only distressing for the patient and family, but also produce secondary adverse physiological and functional changes.
Pain and the accompanying allodynia and hyperalgesia produce learned disuse (illustrated by Bruehl67). There is significant kinesophobia as the patient adopts a protective posture and minimizes movement that is expected to increase the pain. Pain itself can increase circulating catecholamine, aggravating the vasospasm. Dysphoric states such as anger, anxiety, and depression are common and perpetuate the pain state. It is postulated that these vicious cycles eventually maintain the CRPS. Successful treatment therefore must address symptoms beyond the vasospasm.
It is therefore not surprising that cognitive/behavioral treatments are reported to be effective in the management of chronic pain states, including CRPS.68[I] There are, of course, no randomized controlled studies of these methods in CRPS, but the published reports, as usual, are supportive (reviewed by Bruehl67).
The paucity of data in this area suggests that therapy should be in a comprehensive, integrated interdisciplinary model.
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