Psych CRPS
Background: Complex regional pain syndrome (CRPS) is a multifactorial condition and frequently affects patients after sustaining a fracture in the upper and lower extremity. Prior investigations have formed a foundation for exploring a possible association between psychiatric disorders and development of CRPS, however there remains a lack of consensus in the literature about this relationship. The purpose of this study was to determine if pre-existing anxiety and mood disorders (AMDs) elevate the risk of developing CRPS after a fracture. Awareness of precipitating factors is of utmost importance given the significant morbidity associated with CRPS.
Questions/Purpose:
1) Does a pre-existing AMD increase the risk of developing CRPS after an upper extremity fracture?
2) Does a pre-existing AMD increase the risk of developing CRPS after a lower extremity fracture?
3) Does a pre-existing AMD increase the risk of developing CRPS when undergoing surgical fixation of a fracture?
Methods: A large retrospective cohort study was conducted using multi-center EMR data from over 100 million patients. The cohort included 676,332 patients older than 18 with upper or lower extremity fractures between 2003 and 2022. Patients with polytrauma and/or concurrent upper and lower extremity fractures were excluded. Propensity score matching was performed to balance cohorts based on age, sex, race, and comorbidities. Risk ratios, hazard ratios, and Aalen-Johansen cumulative incidence curves for development of CRPS were calculated for patients with and without AMD diagnoses prior to fracture. A subanalysis was performed in which we examined individuals who underwent surgical treatment within both upper and lower extremity fracture cohorts.
Results: Patients with pre-existing AMDs were found to have over twice the risk of developing CRPS after an upper extremity fracture compared to patients without AMDs (risk ratio: 2.089, p<0.001).
Patients with pre-existing AMDs were found to have over twice the risk of developing CRPS after a lower extremity fracture compared to patients without AMDs (risk ratio: 2.416, p<0.001).
Patients undergoing surgical repair of upper or lower extremity fractures had increased risk of developing CRPS if they had pre-existing AMDs (risk ratio: 1.536 and 2.460 respectively, p<0.001 and p<0.001 respectively).
Conclusion: This large cohort study shows that pre-existing AMDs are significant risk factors for developing CRPS after a fracture of either the upper or lower extremity. Even when only assessing patients who required surgical fixation, pre-existing AMDs remained a significant risk factor for developing CRPS. These findings may help identify patients at-risk for CRPS and guide development of targeted preventive measures and treatments.
