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The Role of Pain Coping and Kinesiophobia in Patients With Complex Regional Pain Syndrome Type 1 of the Legs

Marinus, Johan PhD*,†; Perez, Roberto S. PhD†,‡,§; van Eijs, Frank MD, PhD†,∥; van Gestel, Miriam A. PhD†,¶; Geurts, José W. MSc†,#; Huygen, Frank J. MD, PhD†,**; Bauer, Martin C. MD†,††; van Hilten, Jacobus J. MD, PhD*,†

doi: 10.1097/AJP.0b013e31826f9a8a
Original Articles

Objectives: The aim of this cross-sectional study was to evaluate to what extent pain coping and kinesiophobia contribute to limitations in activity and participation in patients with complex regional pain syndrome type 1 (CRPS-1) of the lower limbs.

Methods: A total of 238 patients with CRPS-1 of the legs from 4 pain clinics and 1 Department of Neurology of University Hospitals participated in this study. Pain and CRPS severity were assessed with the pain rating index of the McGill Pain Questionnaire and the CRPS Severity Score, respectively. Activity was measured with the Rising & Walking scale, and participation with the Social Functioning scale of the SF-36. In addition, the Tampa Scale for Kinesiophobia and Pain Coping Inventory were administered. Hierarchical linear regression was used to evaluate to what extent kinesiophobia and pain coping contributed to difficulties with Rising & Walking and Social Functioning.

Results: The analyses showed that the “resting” subscale of the Pain Coping Inventory—that is, 1 of the 3 scales evaluating passive pain coping strategies—contributed significantly to difficulties in rising and walking (explaining 12.5% of the variance) and to difficulties in social functioning (explaining 6.5%), whereas kinesiophobia was not associated with either of these measures.

Discussion: These findings indicate that making use of “resting” as a pain coping strategy contributes significantly to limitations in activity and participation in patients with CRPS-1 of the legs. Indications for a negative influence of kinesiophobia or a positive influence of an active pain coping style were not found.

Departments of *Neurology

Medical Statistics and BioInformatics

††Anesthesiology, Leiden University Medical Center

Knowledge Consortium TREND, Leiden

Department of Anesthesiology, VU University Medical Center

§Institute for Extramural Medicine (EMGO), Amsterdam

Department of Anesthesiology, Saint Elisabeth Hospital, Tilburg

#Department of Anesthesiology, Maastricht University Medical Center, Maastricht

**Department of Anesthesiology, Erasmus Medical Center, Rotterdam, The Netherlands

Supported by a grant from the Netherlands’ Ministry of Economic Affairs, Bezuidenhoutseweg 30, 2594 AV, The Hague, The Netherlands [grant number BSIK03016]. The authors declare no conflict of interest. This study was performed within TREND (Trauma RElated Neuronal Dysfunction), a knowledge consortium that integrates research on complex regional pain syndrome type 1 (for more information see http://www.trendconsortium.nl).

Reprints: Johan Marinus, PhD, Department of Neurology (K5), Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands (e-mail: j.marinus@lumc.nl).

Received January 27, 2012

Accepted August 16, 2012

© 2013 by Lippincott Williams & Wilkins