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Psychological and Behavioral Aspects of Complex Regional Pain Syndrome Management

Bruehl, Stephen PhD; Chung, Ok Yung MD, MBA

The Clinical Journal of Pain: June 2006 - Volume 22 - Issue 5 - p 430-437
doi: 10.1097/01.ajp.0000194282.82002.79
Special Topic Series Management of Complex Regional Pain Syndrome

Psychological and behavioral factors can exacerbate the pain and dysfunction associated with complex regional pain syndrome (CRPS) and could help maintain the condition in some patients. Effective management of CRPS requires that these psychosocial and behavioral aspects be addressed as part of an integrated multidisciplinary treatment approach. Well-controlled studies to guide the development of a psychological approach to CRPS management are not currently available. A sequenced protocol for psychological care in CRPS is therefore proposed based on available data and clinical experience. Regardless of the duration of the condition, all CRPS patients and their families should receive education about the negative effects of disuse, the pathophysiology of the syndrome, and possible interactions with psychological/behavioral factors. Patients with acute CRPS (<6–8 weeks) may not need additional psychological care. All patients with chronic CRPS should receive a thorough psychological evaluation, followed by cognitive-behavioral pain management treatment, including relaxation training with biofeedback. Patients making insufficient overall treatment progress or in whom comorbid psychiatric disorders/major ongoing life stressors are identified should additionally receive general cognitive-behavioral therapy to address these issues. The psychological component of treatment can work synergistically with medical and physical/occupational therapies to improve function and increase patients’ ability to manage the condition successfully.

Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, TN

Reprints: Stephen Bruehl, PhD, Vanderbilt University Medical Center, Suite 324 Medical Arts Building, 1211 Twenty-First Avenue South, Nashville, TN 37212 (e-mail:

Received for publication July 25, 2005; accepted July 25, 2005

© 2006 Lippincott Williams & Wilkins, Inc.