Psychiatric Comorbidity and Complex Regional Pain Syndrome Through the Lens of the Biopsychosocial Model: A Comparative Study

Figures & data

Table 1 The INTERMED and Its Items

Domains	History	Current State	Prognoses
Biological	Chronicity Diagnostic uncertainty	Severity of illness Clarity of diagnostic profile	Complications and life threat (short term) (long term)
Psychological	Restrictions in coping Premorbid level of psychiatric dysfunctioning	Treatment resistance Severity of psychiatric symptoms	Mental health treat (short term) (long term)
Social	Family disruption Impairment of social support	Residential instability Impairment of social integration	Social vulnerability (short term) (long term)
Health care	Intensity of prior treatment Prior treatment experience	Organizational complexity at admission or referral Appropriateness of admission or referral	Care needs (short term) (long term)

Notes: Reprinted from Huyse FJ, Lyons JS, Stiefel FC, et al. “INTERMED”: a method to assess health service needs. I. Development and reliability. Gen Hosp Psychiatry. 1999;21(1):39–48. Copyright 1999, with permission from Elsevier.²²

Table 2 Comparisons of Sociodemographic and Clinical Characteristics Between CRPS and Non-CRPS Patients

		CRPS N=103	Non-CRPS  N=290	OR (95% CI)	p-value
Gender (n, %)	Women	36 (35%)	32 (11%)	4.33 (2.41–7.76)	<0.001
Age (years)	Median, interquartile	42 (33–52)	41 (31–49)	1.02 (0.99–1.04)	0.06
Interval between trauma and hospitalization (months)	Median, interquartile	8.4 (5.8–12.0)	11.6 (6.8–18.8)	0.97 (0.93–1.00)	0.12
Initial injury (n, %)	Radius/forearm fracture	24 (23%)	59 (20%)	1.19 (0.66–2.09)	0.53
	Hand fracture	22 (21%)	59 (20%)	1.06 (0.58–1.89)	0.83
	Ligament injury	12 (12%)	47 (17%)	0.68 (0.31–1.38)	0.27
	Contusions, sprains	14 (14%)	33 (11%)	1.23 (0.58–2.48)	0.55
	Simple wound	18 (17%)	31 (11%)	1.77 (0.88–3.45)	0.07
	Finger amputation/complex hand injury	13 (13%)	61 (21%)	0.54 (0.26–1.06)	0.06
Surgery	n, %	66 (64%)	237 (82%)	0.39 (0.24–0.64)	<0.001
VAS score (0–100mm)	Mean, SD	54.5 (27.3)	51.9 (26.2)	1.00 (0.99–1.01)	0.43
DASH score (0–100)	Mean, SD	60.1 (16.9)	49.9 (17.5)	1.04 (1.02–1.05)	<0.001

Note: Significant p-values (<0.05) are in bold.

Abbreviations: CRPS, complex regional pain syndrome; OR (95% CI), odds ratio and 95% confidence interval; SD, standard deviation; VAS, Visual Analog Scale; DASH, Disabilities of the Arm, Shoulder and Hand.

Figure 1 Flow chart of the study.

Table 3 Psychiatric Comorbidity and BPS Profile Between CRPS and Non-CRPS Patients

		CRPS N=103	Non-CRPS N=290	OR (95% CI)	p-value
Psychiatric comorbidities	Total	30 (29%)	61 (21%)	1.54 (0.93–2.57)	0.10
(n, %)	Adjustment disorders with mixed depression and anxiety	17 (17%)	39 (13%)
	Depressive disorders	7 (7%)	11 (4%)
	Post-trauma stress disorders	3 (3%)	4 (1%)
	Personality disorders	3 (3%)	4 (1%)
	Mental disorders (related to alcohol)	0	3 (1%)
BPS complexity	INTERMED total scores (median, interquartile)	23 (18–27)	23 (20–27)	0.99 (0.96–1.03)	0.81
	INTERMED ≥ 21 points (n, %)	69 (67%)	206 (71%)	0.83 (0.51–1.34)	0.61
INTERMED subscales (median, interquartile)	Biological	9 (8–10)	9 (8–10)	0.98 (0.83–1.15)	0.77
	Psychological	4 (2–7)	4 (2–7)	1.03 (0.95–1.12)	0.41
	Social	5 (3–6)	5 (4–7)	0.93 (0.83–1.04)	0.20
	Health care	4 (3–5)	4 (3–5)	0.92 (0.82–1.07)	0.33

Abbreviations: CRPS, complex regional pain syndrome; OR (95% CI), odds ratio and 95% confidence intervals.

Table 4 Results of the Multiple Logistic Regression Analyses (Adjusted for Age, Gender and Pain) Between BPS Complexity Assessed by Means of the INTERMED and Presence of Psychiatric Comorbidity in the Two Groups

	CRPS (N=103)			Non-CRPS (N=290)			OR Between-Group Comparisons
	OR	95% CI	p-value	OR	95% CI	p-value	p-value
INTERMED	Continuous scores
Total	1.46	1.23–1.73	<0.001	1.21	1.13–1.30	<0.001	0.24
Biological	2.10	1.30–3.39	0.002	1.36	1.05–1.75	0.017	0.25
Psychological	2.37	1.62–3.48	<0.001	1.65	1.39–1.97	<0.001	0.32
Social	2.11	1.48–3.02	<0.001	1.43	1.19–1.71	<0.001	0.10
Health care	1.56	1.15–2.11	0.002	1.34	1.10–1.63	0.001	0.46

Note: Significant p-values (<0.05) are in bold.

Abbreviations: CRPS, complex regional pain syndrome; OR (95% CI), odds ratio and 95% confidence intervals.

Huyse FJ, Lyons JS, Stiefel FC, et al. “INTERMED”: a method to assess health service needs. I. Development and reliability. Gen Hosp Psychiatry. 1999;21(1):39–48. doi:10.1016/S0163-8343(98)00057-7

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