Factors associated with disability and pain intensity in patients with complex regional pain syndrome

Abstract

Purpose

To examine the associations between psychological factors (pain catastrophizing, pain-related anxiety, and fear of pain) and level of pain and disability in patients with complex regional pain syndrome (CRPS).

Methods

One hundred and two patients with CRPS were recruited from tertiary care centers with the different upper limb injuries were evaluated for pain, disability, and psychological factors. Patients completed the Disabilities of the Arm, Shoulder, and Hand (DASH) Questionnaire, Patient Rated Wrist Evaluation (PRWE), Pain Catastrophizing Scale (PCS), Tampa Scale of Kinesiophobia (TSK-11), and Depression, Anxiety, and Stress Scale (DASS). The associations of pain and disability with presence of these behavioral and mental health factors were examined using bivariate and multivariable analyses. These models were adjusted for age, sex, injured dominant hand, and previous surgery.

Results

A higher pain catastrophizing score (β = 0.55, p = 0.00) was associated with greater disability. A higher pain catastrophizing score (β = 0.35, p = 0.001) and female gender (β = 0.24, p = 0.01) were associated with greater pain at rest (PAR). A higher pain catastrophizing score and having a surgical history were associated with greater pain with movement (β = 0.25, p = 0.02). Scores of ≥18.5 in PCS, ≥57.5 on TSK, and ≥15.5 on DASS were associated with higher risk of experiencing pain and disability.

Conclusions

Pain catastrophizing, female sex, and surgical intervention are associated with poor outcomes. Physiologic, psychological factors, and treatment factors interact to influence outcomes. The results of this study further validate the associations of chronic pain and disability with pain catastrophizing in patients with CRPS. The novel finding of this study is introducing cut-off scores for TSK, PCS, and DASS as a screening tool to predict pain, functional limitations.

Implication for rehabilitation

• Pain catastrophizing has a vital role in the magnitude of disability and pain in patients with CRPS.

• The novel finding of this paper was the cut-off scores on the psychological evaluations that can enable using them as screening tool for bad outcomes in patients with CRPS.

• Cut off scores from different psychological evaluations can be used as a yellow flag for clinician’s for detecting patients with increased risk of pain and disability.

• The identification of a cut-off can also have implications for implementing change in clinical practice by identifying the need for early and intensive interventions.

Keywords:

• Complex regional pain symptom
• pain at rest
• movement evoked pain
• pain catastrophizing
• kinesiophobia
• psychological factors

Acknowledgements

Joy MacDermid was supported by a Canada Research Chair in Musculoskeletal Health Outcomes and Knowledge Translation and the Dr James Roth Chair in Musculoskeletal Measurement and Knowledge Translation.

Our local ethics committee approved the research process IR.USWR.REC.1398.098; University of Social Welfare and Rehabilitation Sciences.

Consent of publication: This study does not include any personal information of the patients.

Author contributions

Maryam Farzad: made substantial contributions to the conception and design, drafting the article, participated in drafting, and revising the article, analyzing the data, and reporting the results, conducted data gathering, data entry, and analyzing the data. Tara Packham: participated in revising the article critically for important intellectual content and gave final approval of the version to be published. Made substantial contributions to the conception and designing the study.

Disclosure statement

There is no conflict of interest to declare.