Psychological stress is not the cause of CRPS

Introduction

Complex Regional Pain Syndrome (CRPS) is a condition that's often misunderstood, both medically and psychologically. 

One common misconception is that CRPS is caused by psychological factors like anxiety and depression. 

The Myth: CRPS is Caused by Psychological Factors

There's a common assumption that CRPS may be triggered by anxiety or depression.

However, this idea largely stems from the condition's unpredictable nature and the fact that CRPS patients often exhibit heightened levels of anxiety and depression. Yet, research tells us a different story.

• Large Studies: Two of the largest studies exploring psychological risk factors for CRPS found no evidence to support the claim that anxiety or depression predisposes individuals to CRPS.
• Comparison Study: One significant population-based case-control study found no difference in psychological variables between those who developed CRPS after trauma and those who did not.
• Future-Oriented Study: Another study including almost 600 patients with a single fracture showed that none of the psychological factors predicted the development of CRPS.

The Reality: CRPS Can Lead to Anxiety and Depression

While psychological factors may not cause CRPS, living with the condition can often leads to serious emotional distress. 

Patient quotes:
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“When am I going to be back to normal? But no one can tell ya. That plays a big part, I think. The mental side of it is probably worse than the pain side of it. So, I reckon it’s the stress of it all”

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[This CRPS].... just takes all of the pleasure out of your life”

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“I call it the Beast. So how do you adjust with living with this beast that has the ability to rear its head and potentially take over my life. All I can do is just lie back as much as I can. So yeah it is quite overwhelming at times”

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Most studies provide compelling evidence that CRPS patients are more anxious and depressed than healthy controls (although CRPS patients are not more anxious or depressed than people with other types of chronic pain). 

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The Complexity: Emotional State Can Affect CRPS Symptoms

Once a person has CRPS, their emotional state can indeed influence the condition's symptoms. Anxiety and stress tend to exacerbate CRPS symptoms, adding another layer of complexity to its management. 

It's a cyclic relationship: CRPS can cause emotional distress, and emotional distress can in turn make CRPS symptoms worse.

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What Does This Mean for Patients and Families?

• Don't Blame Yourself: If you or a family member has CRPS, know that it's not caused by psychological factors. You're not to blame.
  

• Seek Comprehensive Care: Treatment should not just focus on physical symptoms; emotional well-being is also crucial. Consider speaking to mental health professionals alongside your medical treatment.
  

• Be Mindful of Emotional Triggers: Being aware that stress and anxiety can worsen symptoms can help in managing CRPS more effectively. Stress management techniques may be a helpful component of your self-care program.
  

“Seeing the psychologist has helped a lot. That’s made a huge difference. I guess I really needed someone to talk to and sort of guide me through…"

Conclusion

The relationship between CRPS, anxiety, and depression is complex but it's clear that psychological factors are not the root cause of CRPS.  More research is being done, but it's clear that effective treatment needs to focus on both the physical and emotional challenges of living with CRPS.

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Sources for this post:

• The article "Clinical features and pathophysiology of complex regional pain syndrome." published in the journal "The Lancet Neurology" in 2011
• The article "An update on the pathophysiology of complex regional pain syndrome." published in The Journal of the American Society of Anesthesiologists in 2010
• The article "Exploring peoples’ lived experience of complex regional pain syndrome in Australia: a qualitative study." published in the Scandinavian Journal of Pain in 2021