Predisposing psychological factors in the development of reflex sympathetic dystrophy. A review of the empirical evidence.

OBJECTIVE To examine the literature for evidence that psychological factors predispose certain individuals to development of reflex sympathetic dystrophy (RSD). DATA SOURCES English-language journal articles that described psychological data on patients diagnosed with RSD, identified through Medline search and bibliography reviews. STUDY SELECTION All studies reporting data on psychological factors in adult, adolescent, or child patients with RSD were included. DATA EXTRACTION We extracted data regarding psychological factors in patients with RSD and assessed validity of these studies through evaluation against seven basic research criteria. DATA SYNTHESIS 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. CONCLUSIONS 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.