ABSTRACT
OBJECTIVE: To determine to what extent stressful life events and psychological dysfunction play a role in the pathogenesis of Complex Regional Pain Syndrome type I (CRPS). DESIGN: A comparative study between a CRPS group and a control group. Stressful life events and psychological dysfunction evaluation was performed with a life event rating list and the Symptom Checklist-90 (SCL-90). SETTING: A university hospital. SUBJECTS: The CRPS group consisted of 24 patients with a history of upper extremity CRPS of less than 3 months. The control group consisted of 42 hand pathology patients waiting for elective hand surgery within the next 24 hours. MAIN OUTCOME MEASURES: Stressful life event rating was measured using the Social Readjustment Rating Scale. Psychological dysfunction was measured using the SCL-90. RESULTS: Stressful life events were experienced by 19 patients (79.2%) in the CRPS group and by 9 patients (21.4%) in the control group. This difference was significant. Testing of psychological dysfunction (SCL-90) in CRPS patients and the control group demonstrated some significant differences: male patients were more anxious than male controls; female patients were statistically more depressed, had feelings of inadequacy, and were emotionally less stable than female controls. In multivariate analysis, no significant differences were found across gender, age, or gender x group interactions. Of the SCL-90 dimensions, only insomnia correlated with the experienced stressful life events. CONCLUSION: Stressful life events are more common in the CRPS group, which indicates that there may be a multiconditional model of CRPS. The experience of stressful life events besides trauma or surgery are risk factors, not causes, in such a model.
Subject(s)
Life Change Events , Mental Disorders/etiology , Reflex Sympathetic Dystrophy/prevention & control , Stress, Psychological/psychology , Adult , Aged , Analysis of Variance , Female , Humans , Male , Middle AgedABSTRACT
This article presents the results of a pilot study evaluating the efficacy of a mass media self-help behavioral treatment program for chronic headache. The program consisted of a self-help textbook, an exercise book, 10 television programs, 11 radio programs, and 3 audiocassettes with relaxation training. Approximately 15,000 headache sufferers purchased the book and relaxation tapes. A random sample of 271 respondents participated in the effect study; the pretraining and posttraining data of 164 subjects were available for analysis. Multivariate testing of the pretraining and posttraining results showed highly significant reductions in headache activity and medication intake at 4-month follow-up. A reduction of 50% or more in headache parameters and medication intake was achieved by 40% to 60% of the patients. Work absenteeism was significantly reduced. The differences between the diagnostic groups were not significant. Mass media behavioral treatment seems to be a viable treatment alternative for chronic headache and highly promising in terms of gain in quality of life, decrease in economic loss, and cost-effectiveness in health care.
Subject(s)
Behavior Therapy/methods , Headache/therapy , Mass Media , Self Care/methods , Adult , Analgesics/therapeutic use , Chronic Disease , Evaluation Studies as Topic , Female , Headache/drug therapy , Headache/prevention & control , Humans , Male , Middle Aged , Netherlands , Pilot Projects , Vasoconstrictor Agents/therapeutic useABSTRACT
We report the results of two prospective studies of early treatment and psychological aspects in a series of 26 patients with sympathetic reflex dystrophy of the hand in which treatment was started within 3 months after diagnosis. Ismelin blocks is an often used therapy in sympathetic reflex dystrophy but a probable better therapy in the first stage of the dystrophy was also investigated. Thirteen patients were treated with Regional Intravenous Ismelin blocks and 13 other patients were treated with a hydroxyl radical scavenger, dimethylsulfoxide (DMSO). After 9 weeks there was a better result in the group treated with DMSO. This report also describes psychological research in a group of 24 dystrophy patients compared with a control group of 42 patients who underwent elective hand-surgery. Women dystrophy patients were more depressed and emotionally unstable. Eighty percent of all dystrophy patients had a recent life-event while only 20% of the control group members reported such an event. These two features seem to be independent. Early diagnosis in combination with early stress management training and a multidisciplinary treatment tends to be a very good solution.
