Neglect-like symptoms in complex regional pain syndrome: Results of a self-administered survey

Reflex sympathetic dystrophy (RSD), recently reclassified as a complex regi onal pain syndrome, type I (CRPS- I), is best known for its disabling senso ry symptoms, including pain, allodynia, and abnormal skin temperature. Yet, motor dysfunction is common in CRPS and can result in major disability. In addition to weakness of the involved limb, CRTS patients,may develop sympt oms akin to a neurological neglect-like syndrome, whereby the limb may feel foreign ("cognitive neglect") and directed mental and visual attention is needed to move the limb ("motor neglect"). Members of the patient support g roup, the Reflex Sympathetic Dystophy Syndrome Association (RSDSA), were ma iled a questionnaire inserted in their newsletter which inquired about the presence of these neglect-like symptoms; in addition, a separate medical hi story questionnaire runs included to assess adequate documentation for the diagnosis of CRTS. A total of 242 patients returned the questionnaire but o nly 224 of the questionnaires were analyzed; 15 were excluded due to inadeq uate documentation of CRPS and 3 were excluded due to non-limb involvement. Eighty-four percent (84 %) of these respondents endorsed the presence of a t least one neglect symptom and 47 % indicated they had both "cognitive" an d "motor" neglect symptoms. Of interest, approximately 33 % of respondents spontaneously wrote comments regarding the significant disability due to th ese neglect symptoms and the difficulty explaining these unusual symptoms t o their health care providers and family. This patient survey confirms the presence of neglect-like symptoms in a subset of CRPS patients. Neglect-lik e symptoms need to be addressed and validated by health care providers. (C) U.S. Cancer Pain Relief Committee, 1999.