Complex regional pain syndrome type 1 in the medico

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. 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). 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). 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 har