Understand Myths in the History of Complex Regional Pain Syndrome


Complex regional pain syndrome, called CRPS, is a little understood but often very disabling condition that can occur after a seemingly small injury or trauma. The pain from the injury is out of proportion of the actual injury and can get worse, rather than better. It usually affects one limb or hand or foot, but can spread to the entire limb with time. Since doctors and researchers don’t know what causes CRPS, there are many theories, some of which include psychiatric or psychological factors. Precisely because the causes aren’t known, perhaps too much emphasis is placed on the alleged mental side of the condition, resulting in myths that continue to be present. The authors of this article wanted to find these myths and understand the evidence of what brought people to believe them.

Complex regional pain syndrome has been around for a very long time – it was first noticed in the sixteenth century and was documented during the Civil War in the United States. It was originally named causalgia (from the Greek word kausis, which mean fire) because of the intense burning pain caused by CRPS. The condition was officially named reflex sympathetic dystrophy in 1939, but was changed to CRPS when it was decided that this was a more fitting description. It may be no surprise that if a condition is difficult to name, it may be difficult to understand.

How CRPS comes on differs from person to person – it can come on very quickly and suddenly or it can develop slowly. It can be caused by a fracture, a nerve injury, after surgery, or just about any other way you can injure yourself – even after an injection. The symptoms can include increase in pain (hyperalgesia), pain from something that isn’t normally painful (allodynia), swelling (edema), changes in skin color, muscle wasting (atrophy), excessive sweating in that one particular area (hyperhidrosis, and/or decrease in bone mineral density (osteopenia).

If the presentation (how it comes on and the symptoms) isn’t confusing enough, the parts of the body that are affected can vary tremendously as well. In some patients, the pain starts and stays in the area of the initial injury, but for others, it could be the mirror image – the opposite limb – that has the pain. It may start as soon as the injury occurs or triggered by delayed (or no) treatment.

It’s not a common disorder, but it’s not rare. CRPS happens after about one to two percent of fractures, after two to four percent of peripheral (surface) nerve injuries, and after up to 35 percent of Colles fractures, a specific type of broken wrist. More women have it than men (60 to 80 percent) and it happens more often after arm or hand injuries than leg or foot injuries.

The myths associated with CRPS are numerous but we don’t have to look far in history to see physical illnesses that are blamed on psychological problems. Most recently, fibromyalgia has been in that group as well. It seems that if there is unexplained pain, theorists will find a way to blame it on a mental problem. For example, some theorists said that patients with CRPS had psychologic disturbances and maladaptive personalities. When the inkblot tests were at their height of popularity (the Rorschack Inkblot Test), they were used on patients with CRPS to see if a psychological issue could be identified. And, because CRPS occurred more often in women, the term hysteria was also applied to patients with CRPS. Then, in the early twentieth century, doctors and researchers were learning more about psychosomatic disorders, physical complaints caused by mental issues, so this exploration was perfect for unknown illnesses, such as CRPS.

What the researchers involved in this study found was that the causes of CRPS were often attributed to the Zeitgeist of the time, the general rule of thought. As certain theories became popular, they were applied to CRPS, in an effort to explain it. However, through looking through the literature, the researchers could not find any evidence to support a relationship between the disorder and a psychological disorder, debunking much of what had been said about such a connection. However, the authors do not say that there is no psychological connection. Managing chronic pain does usually include an approach from a psychological angle as part of a multi-disciplinary approach. The trick is to keep in mind that they go together and that one doesn’t supersede the other.