Views & Reviews Personal View

Complex regional pain syndrome medicalises limb pain

BMJ 2014; 348 doi: http://dx.doi.org/10.1136/bmj.g2631 (Published 28 April 2014) Cite this as: BMJ 2014;348:g2631
  1. Christopher Bass, consultant liaison psychiatrist, John Radcliffe Hospital, Oxford OX3 9DU, UK
  1. Christopher.bass{at}oxfordhealth.nhs.uk

Psychosocial factors may be more important than biomedical ones in type 1 disorder, writes Christopher Bass

I am a psychiatrist who has worked in general hospitals and pain clinics since the 1970s and have assessed many patients given a diagnosis of type 1 complex regional pain syndrome (CRPS). The syndrome is often diagnosed by inexperienced junior doctors when confronted by patients with unexplained symptoms, especially pain in the hands and feet. CRPS was once called algodystrophy, then reflex sympathetic dystrophy, but by 1994 the sympathetic component was abandoned and the current term was introduced.1 CRPS is part of a larger problem in chronic pain and reflects our lack of knowledge of causal mechanisms.

It has been my impression that increasing numbers of patients are being diagnosed with this disorder, and that incidence rates are increasing (estimates in 2007 of 50 000 new cases annually in USA).2 In my opinion excessive reliance on this so called biomedical diagnosis for these patients is misguided. How has this occurred?

Several new diagnostic criteria have been proposed,3 but they are not sufficiently objective or reliable.4 For example, criteria such as “continuing pain that is disproportionate to …

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