Predisposing Psychological Factors in the Development of Reflex Sympathetic Dystrophy

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Abstract
To examine the literature for evidence that psychological factors predispose certain individuals to development of reflex sympathetic dystrophy (RSD). English-language journal articles that described psychological data on patients diagnosed with RSD, identified through Medline search and bibliography reviews. All studies reporting data on psychological factors in adult, adolescent, or child patients with RSD were included. We extracted data regarding psychological factors in patients with RSD and assessed validity of these studies through evaluation against seven basic research criteria. Of the 20 articles reviewed, 15 reported the presence of depression, anxiety, and/or life stress in patients with RSD. However, the methodological quality of these studies was generally poor, with most meeting three or less of the seven validity criteria. In particular, the absence of prospective designs restricts conclusions concerning whether psychological factors are etiologically related to RSD. The data reviewed are consistent with a theoretical model in which depression, anxiety, or life stressors may influence development of RSD through their effects on alpha-adrenergic activity. However, conclusions regarding etiological significance of these factors are not possible due to the dearth of high-quality studies. Suggestions for prospective research are described.

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