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Hong Phuoc Duong,1 Michel Konzelmann,1,2 Philippe Vuistiner,1 Cyrille Burrus,1,2 Bertrand Léger,1 Friedrich Stiefel,3 François Luthi1,2,4 1Department of Medical Research, Clinique Romande de Réadaptation, Sion, Switzerland; 2Department of Musculoskeletal Rehabilitation, Clinique Romande de Réadaptation, Sion, Switzerland; 3Psychiatric Liaison Service, Lausanne University and Lausanne University Hospital, Lausanne, Switzerland; 4Department of Rheumatology and Rehabilitation, Hôpital Orthopédique, University and University Hospital of Lausanne, Lausanne, SwitzerlandCorrespondence: Bertrand Léger Tel +41 27 603 2075Fax +41 27 603 2072Email Bertrand.Leger@crr-suva.chPurpose: To compare the prevalence of psychiatric comorbidity between patients with complex regional pain syndrome (CRPS) of the hand and non-CRPS patients and to assess the association between biopsychosocial (BPS) complexity profiles and psychiatric comorbidity in a comparative study.Patients and Methods: We included a total of 103 patients with CRPS of the hand and 290 patients with chronic hand impairments but without CRPS. Psychiatric comorbidities were diagnosed by a psychiatrist, and BPS complexity was measured by means of the INTERMED. The odds ratios (OR) of having psychiatric comorbidities according to BPS complexity were calculated with multiple logistic regression (adjusted for age, sex, and pain).Results: Prevalence of psychiatric comorbidity was 29% in CRPS patients, which was not significantly higher than in non-CRPS patients (21%, relative risk=1.38, 95% CI: 0.95 to 2.01 p=0.10). The median total scores of the INTERMED were the same in both groups (23 points). INTERMED total scores (0– 60 points) were related to an increased risk of having psychiatric comorbidity in CRPS patients (OR=1.46; 95% CI: 1.23– 1.73) and in non-CRPS patients (OR=1.21; 95% CI: 1.13– 1.30). The four INTERMED subscales (biological, psychological, social, and health care) were correlated with a higher risk of having psychiatric comorbidity in both groups. The differences in the OR of having psychiatric comorbidity in relation to INTERMED total and subscale scores were not statistically different between the two groups.Conclusion: The total scores, as well as all four dimensions of BPS complexity measured by the INTERMED, were associated with psychiatric comorbidity, with comparable magnitudes of association between the CRPS and non-CRPS groups. The INTERMED was useful in screening for psychological vulnerability in the two groups.Keywords: complex regional pain syndrome, psychiatric comorbidity, biopsychosocial complexity, INTERMED |
