title: Characteristics and period prevalence of self-induced disorder in patients referred to a pain clinic with the diagnosis of complex regional pain syndrome.
abstract: BACKGROUND
  Although there have been a few case reports in the literature of self-inflicted symptoms presenting as complex regional pain syndrome (CRPS), there has been no systematic study. This report investigates the period prevalence and characteristics of self-induced disorders in patients referred to a comprehensive pain clinic with a diagnosis of CRPS.
  
  
  METHODS
  Retrospective chart review was conducted for all cases referred as "neuropathic pain" to a comprehensive pain clinic over a period of 2 years.
  
  
  RESULTS
  Out of 175 consecutive neuropathic pain referrals over a 2-year period, 41 were specifically referred as CRPS. Application of (modified) 1994 IASP CRPS criteria confirmed the diagnosis of CRPS in 11/15 men and in 15/26 women. Four of the 15 women had evidence of active self-induced signs and symptoms (eg, ligation of the limb, ulcerations, bizarre migrating wounds), which abated with casting, strict observation, discussion with the patient, or other intervention. The characteristics of these cases are presented and compared with other similar cases seen in previous years.
  
  
  CONCLUSIONS
  This is the first report of a case series of patients diagnosed as CRPS with self-induced symptoms. We discuss in detail limitations of the study, factors that contribute to the index of suspicion, and the complex nature of the behavior including the overlap between factitious disorder, somatoform disorders, and malingering, whereas we stress the legitimacy of CRPS as a diagnosis.
authors.affiliation: Comprehensive Pain Program, Toronto Western Hospital, Toronto, Ontario, Canada. angela.mailis@uhn.on.ca
authors.forename: Angela
authors.initials: A
authors.lastname: Mailis-Gagnon
authors.forename: Keith
authors.initials: K
authors.lastname: Nicholson
authors.forename: Daniel
authors.initials: D
authors.lastname: Blumberger
authors.forename: Mateusz
authors.initials: M
authors.lastname: Zurowski
mesh_terms: D000328:Adult; D015897:Comorbidity; D020918:Complex Regional Pain Syndromes / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D003937:Diagnosis, Differential; D003951:Diagnostic Errors / Q000517:prevention & control*; D005162:Factitious Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008026:Ligation / Q000009:adverse effects; D008297:Male; D008306:Malingering / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D009864:Ontario / Q000453:epidemiology; D010147:Pain Measurement; D015995:Prevalence; D011584:Psychology; D012189:Retrospective Studies; D016728:Self-Injurious Behavior / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D013001:Somatoform Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000523:psychology