Sex matters in complex regional pain syndrome

Gijsbrecht A J van Velzen, Frank J P M Huygen, Maarten van Kleef, Frank V van Eijs, Johan Marinus, Jacobus J van Hilten, Gijsbrecht A J van Velzen, Frank J P M Huygen, Maarten van Kleef, Frank V van Eijs, Johan Marinus, Jacobus J van Hilten

Abstract

Background: Complex regional pain syndrome (CRPS) is much more prevalent in women than men but potential differences in clinical phenotype have not been thoroughly explored to date. Differences in the clinical presentation between sexes may point at new avenues for a more tailored management approach of CRPS. We therefore explored if in CRPS, the patient's sex is associated with differences in clinical and psychological characteristics.

Methods: In this cross-sectional study of 698 CRPS patients (599 females) fulfilling the Budapest clinical or research criteria, CRPS signs and symptoms, CRPS severity, pain (average pain intensity in the previous week and McGill pain rating index), pain coping (Pain Coping Inventory), physical limitations (Radboud Skills Questionnaire (upper limb), Walking and Rising questionnaire (lower limb)), anxiety and depression (Hospital Anxiety and Depression scale) and kinesiophobia (Tampa scale for kinesiophobia) were evaluated.

Results: Male CRPS patients used more often extreme words to describe the affective qualities of pain, used more passive pain coping strategies, and were more likely to suffer from depression and kinesiophobia.

Conclusion: Sex-related differences are present in CRPS, but the effect is generally small and mainly concerns psychological functioning. A greater awareness of sex-specific factors in the management of CRPS may contribute to achieving better outcomes.

Significance: What is known? Nonsex-specific clinical data of CRPS patients. What is new? Male CRPS patients used more often extreme words to describe the affective qualities of pain, used more passive pain coping strategies, and were more likely to suffer from depression and kinesiophobia.

Conflict of interest statement

None declared.

© 2019 The Authors European Journal of Pain published by John Wiley & Sons Ltd on behalf of European Pain Federation - EFIC®.

Figures

Figure 1
Figure 1
Flow‐chart of inclusion. Bdp‐c, Budapest clinical; Bdp‐r, Budapest research; CRPS, complex regional pain syndrome; TREND, Trauma RElated Neuronal Dysfunction

References

    1. Aaronson, N. , & Muller, M. (1998). Translation, validation, and norming of the Dutch language version of the SF‐36 Health Survey in community and chronic disease populations. Journal of Clinical Epidemiology, 51, 1055–1068. 10.1016/S0895-4356(98)00097-3
    1. Bjelland, I. , Dahl, A. A. , Haug, T. T. , & Neckelmann, D. (2002). The validity of the Hospital Anxiety and Depression Scale. An updated literature review. Journal of Psychosomatic Research, 52, 69–77. 10.1016/S0022-3999(01)00296-3
    1. Bränström, H. , & Fahlström, M. (2008). Kinesiophobia in patients with chronic musculoskeletal pain: Differences between men and women. Journal of Rehabilitation Medicine, 40, 375–380. 10.2340/16501977-0186
    1. De Mos, M. , de Bruijn, A. G. , Huygen, F. J. , Dieleman, J. P. , Stricker, B. H. , & Sturkenboom, M. C. (2007). The incidence of complex regional pain syndrome: A population‐based study. Pain, 129, 12–20. 10.1016/j.pain.2006.09.008
    1. Ellis, P . (2010). The essential guide to effect sizes: Statistical power, meta-analysis, and the interpretation of research results. Cambridge: Cambridge University Press.
    1. Feldman, S. I. , Downey, G. , & Schaffer‐Neitz, R. (1999). Pain, negative mood, and perceived support in chronic pain patients: A daily diary study of people with reflex sympathetic dystrophy syndrome. Journal of Consulting and Clinical Psychology, 67, 776–785. 10.1037/0022-006X.67.5.776
    1. Fillingim, R. B. (2000). Sex, gender, and pain: Women and men really are different. Current Review of Pain, 4, 24–30. 10.1007/s11916-000-0006-6
    1. Fillingim, R. B. , King, C. D. , Ribeiro‐Dasilva, M. C. , Rahim‐Williams, B. , & Riley, J. L. (2009). Sex, gender, and pain: A review of recent clinical and experimental findings. Journal of Pain, 10, 447–485. 10.1016/j.jpain.2008.12.001
    1. Geertzen, J. H. , de Bruijn‐Kofman, A. T. , de Bruijn, H. P. , van de Wiel, H. B. , & Dijkstra, P. U. (1998). Stressful life events and psychological dysfunction in Complex Regional Pain Syndrome type I. Clinical Journal of Pain, 14, 143–147. 10.1097/00002508-199806000-00009
    1. Greenspan, J. D. , Craft, R. M. , LeResche, L. , Arendt‐Nielsen, L. , Berkley, K. J. , Fillingim, R. B. , … Traub, R. J. (2007). Studying sex and gender differences in pain and analgesia: A consensus report. Pain, 132(Suppl 1), S26–S45. 10.1016/j.pain.2007.10.014
    1. Haley, W. E. , Turner, J. A. , & Romano, J. M. (1985). Depression in chronic pain patients: Relation to pain, activity, and sex differences. Pain, 23, 337–343. 10.1016/0304-3959(85)90003-X
    1. Harden, R. , Bruehl, S. , & Perez, R. (2010). Development of a severity score for CRPS. Pain, 151, 870–876. 10.1016/j.pain.2010.09.031
    1. Hashmi, J. A. , & Davis, K. D. (2014). Deconstructing sex differences in pain sensitivity. Pain, 155, 10–13. 10.1016/j.pain.2013.07.039
    1. den Hollander, M. , Goossens, M. , de Jong, J. , Ruijgrok, J. , Oosterhof, J. , Onghena, P. , … Vlaeyen, J. W. S. (2016). Expose or protect? A randomized controlled trial of exposure in vivo vs pain‐contingent treatment as usual in patients with complex regional pain syndrome type 1 Pain, 157, 2318–2329. 10.1097/j.pain.0000000000000651
    1. Jensen, M. P. , Turner, J. A. , Romano, J. M. , & Strom, S. E. (1995). The chronic pain coping inventory: Development and preliminary validation. Pain, 60, 203–216. 10.1016/0304-3959(94)00118-X
    1. Jong, J. de, Vlaeyen, J. , Gelder, J. de, & Patijn, J. (2011). Pain‐related fear, perceived harmfulness of activities, and functional limitations in complex regional pain syndrome type I. Journal of Pain, 12, 1209–1218. 10.1016/j.jpain.2011.06.010
    1. Jong, J. de, Vlaeyen, J. , & Onghena, P. (2005). Reduction of pain‐related fear in complex regional pain syndrome type I: The application of graded exposure in vivo. Pain, 116, 264–275. 10.1016/j.pain.2005.04.019
    1. Keogh, E. (2015). Men, masculinity, and pain. Pain, 156, 2408–2412. 10.1097/j.pain.0000000000000328
    1. Keogh, E. , & Denford, S. (2009). Sex differences in perceptions of pain coping strategy usage. European Journal of Pain, 13, 629–634. 10.1016/j.ejpain.2008.07.002
    1. Kraaimaat, F. W. , Bakker, A. , & Evers, A. W. M. (1997). Pijncoping‐strategieën bij chronische pijnpatiënten: De ontwikkeling van de Pijn‐Coping‐Inventarisatielijst (PCI). Gedragstherapie, 30, 185–201.
    1. Kraaimaat, F. W. , & Evers, A. W. M. (2003). Pain‐coping strategies in chronic pain patients: Psychometric characteristics of the pain‐coping inventory (PCI) TL – 10. International Journal of Behavioral Medicine, 10, 343–363. 10.1207/S15327558IJBM1004_5
    1. Lohnberg, J. A. , & Altmaier, E. M. (2013). A review of psychosocial factors in complex regional pain syndrome. Journal of Clinical Psychology in Medical Settings, 20, 247–254. 10.1007/s10880-012-9322-3
    1. Marinus, J. , Moseley, G. L. , Birklein, F. , Baron, R. , Maihöfner, C. , Kingery, W. S. , & van Hilten, J. J. (2011). Clinical features and pathophysiology of complex regional pain syndrome. Lancet Neurology, 10, 637–648. 10.1016/S1474-4422(11)70106-5
    1. Marinus, J. , Perez, R. , & Eijs, F. van (2013). The Role of Pain Coping and Kinesiophobia in Patients With Complex Regional Pain Syndrome Type 1 of the Legs. Clinical Journal of Pain, 29, 563–569. 10.1097/AJP.0b013e31826f9a8a
    1. Mccormick, Z. L. , Gagnon, C. M. , Caldwell, M. , Patel, J. , & Kornfeld, S. (2015). Short‐term functional, emotional, and pain outcomes of patients with complex regional pain syndrome treated in a comprehensive interdisciplinary pain management program. Pain Medicine, 16, 2357–2367. 10.1111/pme.12817
    1. Melzack, R. (1975). The McGill Pain Questionnaire: Major properties and scoring methods. Pain, 1, 277–299. 10.1016/0304-3959(75)90044-5
    1. Munce, S. E. P. , & Stewart, D. E. (2007). Gender differences in depression and chronic pain conditions in a national epidemiologic survey. Psychosomatics, 48, 394–399. 10.1176/appi.psy.48.5.394
    1. Oerlemans, M. H. Vragenlijst Vaardigheden. Retrieved from
    1. Oerlemans, H. M. , & Cup, E. H. (2000). The Radboud skills questionnaire: Construction and reliability in patients with reflex sympathetic dystrophy of one upper extremity. Disability and Rehabilitation, 22, 233–245. 10.1080/096382800296809
    1. Pieretti, S. , Di Giannuario, A. , Di Giovannandrea, R. , Marzoli, F. , Piccaro, G. , Minosi, P. , & Aloisi, A. M. (2016). Gender differences in pain and its relief In Alleva E. (Ed.), Annali Dell'Istituto Superiore Di Sanita (pp. 184–189). Rome: Istituto superiore di sanità.
    1. Roorda, L. D. Walking and Rising questionnaire (WRQ) Dutch. Retrieved from
    1. Roorda, L. D. , Roebroeck, M. E. , Van Tilburg, T. , Molenaar, I. W. , Lankhorst, G. J. , & Bouter, L. M. (2005). Measuring activity limitations in walking: Development of a hierarchical scale for patients with lower‐extremity disorders who live at home. Archives of Physical Medicine and Rehabilitation, 86, 2277–2283. 10.1016/j.apmr.2005.06.014
    1. Rovner, G. S. , Sunnerhagen, K. S. , Björkdahl, A. , Gerdle, B. , Börsbo, B. , Johansson, F. , & Gillanders, D. (2017). Chronic pain and sex‐differences; Women accept and move, while men feel blue. PLoS ONE, 12, e0175737 10.1371/journal.pone.0175737
    1. Spinhoven, P. , Ormel, J. , Sloekers, P. P. A. , Kempen, G. I. J. M. , Speckens, A. E. M. , & Van Hemert, A. M. (1997). A validation study of the Hospital Anxiety and Depression Scale (HADS) in different groups of Dutch subjects. Psychological Medicine, 27, 363–370. 10.1017/S0033291796004382
    1. Thissen, D. , Steinberg, L. , & Kuang, D. (2002). Quick and easy implementation of the Benjamini‐Hochberg procedure for controlling the false positive rate in multiple comparisons. Journal of Educational and Behavioral Statistics, 27, 77–83. 10.3102/10769986027001077
    1. van Velzen, G. A. J. , Perez, R. S. G. M. , van Gestel, M. A. , Huygen, F. J. P. M. , van Kleef, M. , van Eijs, F. , … Marinus, J. (2014). Health‐related quality of life in 975 patients with complex regional pain syndrome type 1. Pain, 155, 629–634. 10.1016/j.pain.2013.12.017
    1. Vanderiet, K. , Adriaensen, H. , Carton, H. , & Vertommen, H. (1987). The McGill Pain Questionnaire constructed for the Dutch language (MPQ‐DV). Preliminary data concerning reliability and validity. Pain, 30, 395–408. 10.1016/0304-3959(87)90027-3
    1. Vlaeyen, J. W. S. , Kole‐Snijders, A. M. J. , Boeren, R. G. B. , & van Eek, H. (1995). Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance. Pain, 62, 363–372. 10.1016/0304-3959(94)00279-N
    1. Ware, J. , & Sherbourne, C. (1994). The MOS 36‐item short‐form health survey (SF‐36). Medical Care, 30, 473–483.

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