Complex regional pain syndrome type 1 in the medico-legal setting: High rates of somatoform disorders, opiate use and diagnostic uncertainty
Complex regional pain syndrome type 1 in the medico-legal setting: High rates of somatoform disorders, opiate use and diagnostic uncertainty
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DOI：
10.1177/0025802418779934
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发表时间：
2018-07-01
影响因子：
1.5
通讯作者：
Yates, Gregory
中科院分区：
文献类型：
--
作者：
Bass, Christopher;Yates, Gregory
目的：本研究的目的是回顾在英国医学法律环境中出现的1型复杂区域性疼痛综合征（CRPS）患者的人口学和临床特征，特别是CRPS与躯体形式疾病之间的关系。方法对2005-2016年50例连续接受精神病学评估的CRPS患者进行回顾性分析。通过面谈和检查医疗/精神病学记录，对精神状态进行了系统评估。30例患者还完成了简短疾病感知问卷（BIPQ）。结果30例患者中女性占60%，平均年龄43岁。22% （n=11）有工作，60% （n=30）领取残疾津贴。上肢（62%,n=31）、下肢（30%,n=15）、两肢（6%,n=3）或其他部位（2%,n=1）均报告有症状。84% （n=42）的患者满足DSM-5当前躯体形式障碍的标准。42% （n=21）有两种以上与疼痛相关的功能性躯体综合征（如非心源性胸痛）病史，42% （n=21）有功能性神经症状（如爪状手症）。BIPQ评分与躯体形式疾病和心理因素介导的疾病（如肠易激综合征）相关的评分相似。38% （n=19）的CRPS诊断在专家中存在争议。60% （n=30）有抑郁史，20% （n=10）有惊恐发作史，18% （n=9）有酒精/药物滥用史。处方阿片类药物的占64% （n=32）。结论卷入诉讼的CRPS患者有较高的既往精神病理（主要是躯体形式障碍）和疼痛相关残疾发生率，其中阿片类药物的使用较为常见。他们可能会对肢体疼痛产生不良反应，这种反应是由不适应疾病的信念形成的。CRPS诊断在医学法律环境中缺乏可靠性，并可能导致医源性伤害
Objective The aim of this study was to review demographic and clinical characteristics of patients with complex regional pain syndrome type 1 (CRPS) seen in a UK medico-legal setting - particularly the relationship between CRPS and somatoform disorders.Methods Fifty consecutive cases of CRPS (interviewed 2005-2016) undergoing psychiatric assessment were reviewed. A systematic assessment of mental states was conducted via interview and examination of medical/psychiatric records. Thirty patients also completed the Brief Illness Perception Questionnaire (BIPQ).Results Sixty per cent of patients (n=30) were female, and the mean age was 43 years. Twenty-two per cent (n=11) were employed, and 60% (n=30) received disability benefits. Symptoms were reported in the upper limb (62%; n=31), lower limb (30%; n=15), both (6%; n=3) or elsewhere (2%; n=1). Eighty-four per cent (n=42) satisfied DSM-5 criteria for current somatoform disorder. A history of more than two pain-related functional somatic syndromes (e.g. non-cardiac chest pain) was found in 42% (n=21) and functional neurological symptoms (e.g. claw-hand') in 42% (n=21). BIPQ scores resembled those associated with somatoform disorders and disorders mediated by psychological factors (e.g. irritable bowel syndrome). In 38% (n=19), the CRPS diagnosis was disputed among experts. A history of depression was noted in 60% (n=30), panic attacks in 20% (n=10) and alcohol/substance misuse in 18% (n=9). Opiates were prescribed to 64% (n=32).Conclusions Patients diagnosed with CRPS involved in litigation have high rates of prior psychopathology (mainly somatoform disorders) and pain-related disability for which opiate use is common. They risk an adverse reaction to limb pain shaped' by maladaptive illness beliefs. The CRPS diagnosis lacks reliability in medico-legal settings and may cause iatrogenic harm