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4525
Complex Regional Pain Syndrome and History of Abuse: Associations with Psychological Well-Being
Session: MP-04a
Thurs, Nov. 16, 3:45-5:15 pm
Hampton Room

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Title: Complex Regional Pain Syndrome and History of Abuse: Associations with Psychological Well-Being

Authors: Jennifer Pierce, Matt Wixson, Stephanie Moser, Afton L. Hassett, Jenna Goesling

Background:

  • Complex Regional Pain Syndrome (CRPS) is a chronic, severe pain condition that may lead to diminished psychological well-being, although findings related to the association between CRPS and depression and anxiety are mixed1.
  • Previous research suggests that CRPS patients report a high number of adverse life events prior to diagnosis1.
  • A history of abuse has also been linked to chronic pain conditions and severity of symptoms2,3.
  • Thus, CRPS patients may report a history of abuse more often compared to other pain patients, and abuse experiences may exacerbate the deleterious effects of the disease on psychological functioning.
  • We explored the association between CRPS diagnosis and abuse history on psychological well-being using a comparison group of patients with a primary diagnosis of low back pain (LBP).  The present study defines psychological well-being as encompassing depression, anxiety, and subjective well-being.
  • We expected that CRPS patients would: 1) be more likely to report a history of abuse, 2) report lower psychological well-being compared to LBP patients, and 3) that abuse history would amplify these effects, such that CRPS patients with a history of abuse would report the lowest psychological well-being overall. 

Materials & Methods:

  • New patients at an outpatient clinic completed a survey assessing pain phenotype and psychological well-being (IRB approval: HUM00041820). 
  • A manual chart review was conducted to determine primary reason for clinic visit. ICD-9 codes and Budapest Criteria were used to determine CRPS Type 1 or 2 diagnosis; LBP patients did not have a diagnosis of CRPS and had low back pain indicated as the primary ICD-9 code. 
  • Participants indicated if they had a history of physical or sexual abuse and when this occurred, including childhood (<13 years), adolescence (13-18 years) and adulthood. 
  • Patients completed measures of psychological well-being, including:
  1. Hospital Anxiety and Depression Scale (HADS): 14 item self-report scale (7 items Anxiety; 7 items Depression).  Each subscale ranges from 0-21.
  2. Subjective Well-Being: Composite measure including the Positive and Negative Affectivity Scale (PANAS) and single item measuring Life Satisfaction.  A total score was obtained by calculating Positive Affect (PA) – Negative Affect (NA) + Life Satisfaction.

Results:

  • Of 877 patients (59.2% female; Mage = 49.7; SD = 15.1), 719 presented with LBP and 158 with CRPS.
  • Approximately 14% of all patients reported abuse in their lifetime.  There was no difference between CRPS patients and LBP patients on the history of any abuse (χ2 = .52, p = .47). 
  • CRPS patients and LBP patients did differ marginally when considering age of abuse (Table 1). 
  1. The difference was primarily driven by CRPS patients reporting more abuse in adulthood only than expected based on marginal frequencies. 
  • The interaction between primary pain condition and abuse history was significant for subjective well-being, depression and anxiety (Table 2). 
  1. For each outcome, LBP patients without a history of abuse reported the highest well-being (high subjective well-being and low depression and anxiety), whereas LBP patients with a history of abuse reported the poorest well-being (low subjective well-being and high depression and anxiety; Figure 1). 
  2. In contrast, CRPS patients’ overall well-being was consistent regardless of abuse history.

Discussion:

  • Contrary to expectations, CRPS patients’ psychological well-being did not differ according to abuse status.
  • LBP patients with a history of abuse reported the lowest psychological well-being overall. 
  • Rates of abuse in the current study may be reduced due to reluctance to report or not labeling such incidences as abuse.
    • Labeling of abuse experiences and recognition of its consequences may be lower among individuals with CRPS as this condition has been linked to higher rates of alexithymia4.
    • Future research is warranted to explore these findings. 

References:

  1. Beerthuizen, A., van ‘t Spijker, A., Huygen, F.J.P.M., Klein, J., & de Wit, R. (2009). Is there an association between psychological factors and the Complex Regional Pain Syndrome type 1 (CRPS1) in adults? A systematic review. Pain, 145, 52-59.
  2. Sachs-Ericsson, N., Cromer, K., Hernandez, A. & Kendall-Tackett, K. (2009). A review of childhood abuse, health, and pain-related problems: The role of psychiatric disorders and current life stress. Journal of Trauma & Dissociation, 10, 170-188.
  3. Lampe, A., Doering, S., Rumpold, G., Solder, E., Krismer, M., Kantner-Rumplmair, W., Schubert, C., & Sollner, W. (2003). Chronic pain conditions and their relation to childhood abuse and stressful life events. Journal of Psychosomatic Research, 54, 361-367.
  4. Margalit, D., Har, L. B., Brill, S., & Vatine, J. J. (2014). Complex regional pain syndrome, alexithymia, and psychological distress. Journal of Psychosomatic Research, 77, 273-277.
  5. Brummett, C. M., Bakshi, R. R., Goesling, J., Leung, D., Moser, S. E., Zollars, J. W., Williams, D. A., Clauw, D. J., & Hassett, A. L. (2016). Preliminary validation of the Michigan Body Map. Pain, 157(6), 1205-1212.  
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