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Complex regional pain syndrome medicalises limb pain

BMJ 2014; 348 doi: (Published 28 April 2014) Cite this as: BMJ 2014;348:g2631

Re: Complex regional pain syndrome medicalises limb pain

It's extraordinary that it has taken a psychiatrist to question the increasing tendency of the largely surgical community to diagnose 'chronic regional pain syndrome'. Dr Christopher Bass has done us an immense service by his observations.

Throughout a career including dealing with second opinion referrals as a hand surgeon and in my expert witness work of assessing upper limb trauma, it has also become clear to me that CRPS is increasingly a 'dustbin' diagnosis. It is often arrived at when inadequate clinical acumen has failed to adequately explore underlying reasons for persistent pain. Examples include sub-acute carpal tunnel syndrome arising after wrist trauma and unidentified bone necrosis after complex fractures. Dr Bass is perfectly correct that once a diagnosis of CRPS is made in the face of an unidentified underlying organic lesion, chronic disability immediately becomes an almost irremovable issue. Moreover, once spinal arcs become established from untreated organic pain sources, even appropriate late treatment may fail to cure the symptom.

In my view the increasing tendency to diagnose CRPS, as identified by Dr Bass, is due to two factors.......first, poorer clinical exposure & training prior to consultancy and second, massively increased pressures in daily clinical life leading to briefer consultations and the need to discharge patients from care. This may appear to save money for the NHS in the short term but the net costs to society of the long term disabilty of an incorrect diagnosis of CRPS are infinitely greater.

Competing interests: No competing interests

02 June 2014
Peter J Mahaffey
Pinehill Hospital, Hitchin
306 Chapel Lane, Cardington, Bedford MK44 3SW