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INTERVIEW | COVINGTON LIFEBOAT mixed media on canvas 36x40 Stephen Spagnoli 40 | T H E PA I N P R A C T I T I O N E R | S P R I N G 2 0 0 6
EXPLORING PSYCHOSOCIAL ISSUES IN CRPS An Interview with Edward C. Covington, MD, Director of the Chronic Pain Rehabilitation Program at the Cleveland Clinic Foundation Q. What is the current thinking about the relationship between the psyche and the soma in CRPS? DR. COVINGTON A recent search for articles on CRPS, which are being published at the rate of about 100 per year, showed that there is still tremendous controversy about the nature of this disease, and whether it is a psychiatric rather than a medical condition. Authors have proposed several theories about how the psyche might be related to the soma in this syndrome, and each has varying support. Some believe that CRPS is a psychiatric illness—a con<strong>version</strong> disorder—that there is something ‘in the head’ that makes it come about. Others see CRPS as a result of a psychiatric illness or personality disorder that makes some more likely to get it than others. Some contend that CRPS causes psychological symptoms or psychiatric illness, while others think that psychological factors modify the course of CRPS— making it better or worse. Others think that adjustment and function in CRPS are determined by psychological factors. CRPS AND PERSONALITY Q. Are people with particular personalities prone to certain diseases? DR. COVINGTON There was a very old theory that held that different personality types were vulnerable to different illnesses. For example, that particular personality types had Crohn’s disease, others had migraine headaches, and that other types had CRPS. These ideas were widely taught, but never substantiated, and had been essentially discredited by the time I was in training 25 years ago. Few people now believe this theory, although occasionally you’ll hear someone refer, for example, to migraineurs as compulsive, but this is essentially just folklore. Q. What about the relationship between personality and CRPS? DR. COVINGTON People often mistakenly equate correlation with causation. Personalities change when people are miserable and unable to function. So CRPS patients may be irritable, complaining, or demanding, leading others to conclude that these traits led to the disease. Another reason people have thought that personality disorders predisposed to CRPS is because there are often extreme behavioral changes following a trivial injury. Thus the inclination is to think, ‘Oh, c’mon, that couldn’t hurt that bad.’ Psychogenic theories also flourished because, despite the last twenty years of research, the condition remains ill-defined. Its pathophysiology is obscure. We don’t have a good understanding of exactly what CRPS is and why some people get it and others don’t. It is common to assume that when no explanation for a condition can be found, then it must be psychogenic. If doctors can’t figure it out, perhaps ‘it’s all in the head.’ People with fibromyalgia and irritable bowel syndrome have been subjected to the same sort of ideas, and I’m convinced that both are absolutely organic diseases, as is CRPS. T H E PA I N P R A C T I T I O N E R | V O L U M E 16 , N U M B E R 1 | 41
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Page 6 and 7: EDITORS’ CORNER | COMPLEX REGIONA
Page 8 and 9: EDITORS’ CORNER | COMPLEX REGIONA
Page 10 and 11: COMMENTARY | GIORDANO Comprehending
Page 16 and 17: FEATURE | BROATCH RSDSA: Expanding
Page 18 and 19: FEATURE | BROATCH We are acutely aw
Page 20 and 21: FEATURE | BROATCH information, such
Page 22 and 23: FEATURE | PATIENT PROFILE PEOPLE WI
Page 24 and 25: PEOPLE WITH CRPS | THEIR STORIES AN
Page 26 and 27: PEOPLE WITH CRPS | THEIR STORIES AN
Page 32 and 33: FEATURE | GALER 32 | T H E PA I N P
Page 34 and 35: FEATURE | GALER TABLE 1 | IASP Diag
Page 36 and 37: FEATURE | GALER Although there is s
Page 38 and 39: FEATURE | GALER 10. Gammaitoni A, G
Page 42 and 43: INTERVIEW | COVINGTON Q. Have any s
Page 45 and 46: Reap the Rewards of Membership Beco
Page 47 and 48: with depression. However, they foun
Page 49 and 50: It is common for patients in pain i
Page 51 and 52: There are multiple forms of amplifi
Page 53 and 54: Okay for Vegas. Not your Practice.
Page 55 and 56: especially opioids. Opioids should
Page 57 and 58: Subscribe to Currents Today! The Ac
Page 59 and 60: FEATURE | COMPLEX REGIONAL PAIN SYN
Page 61 and 62: FEATURE | COMPLEX REGIONAL PAIN SYN
Page 63 and 64: ZICONOTIDE: Promising New Treatment
Page 65 and 66: UNRIVALED INDEPENDENCE COMING SOON
Page 67 and 68: D O YO U G E T I T ? Subscribe to T
Page 69 and 70: SCS as Part of the CRPS Treatment A
Page 72 and 73: OPINION | GETSON The Use of Thermog
Page 74 and 75: IN CONCLUSION | MOSKOVITZ A Theory
Page 76 and 77: IN CONCLUSION | MOSKOVITZ even thin
Page 78 and 79: IN CONCLUSION | MOSKOVITZ Comorbidi
Page 80 and 81: IN CONCLUSION | MOSKOVITZ empathy e
Page 82 and 83: AC ADEMY NEWS | AMERICAN ACADEMY OF
Page 84 and 85: CL ASSIFIED ADS & DIRECTORY | AMERI
Page 86 and 87: RESOURCES | CRPS RESOURCES FOR CRPS
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