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
- 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:
- Hospital Anxiety and Depression Scale (HADS): 14 item self-report scale (7 items Anxiety; 7 items Depression). Each subscale ranges from 0-21.
- 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.
- 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).
- 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).
- 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).
- In contrast, CRPS patients’ overall well-being was consistent regardless of abuse history.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.