Characteristics and Period Prevalence of Self-induced Disorder in Patients Referred to a Pain Clinic With the Diagnosis of Complex Regional Pain Syndrome
Bibliographic record
Abstract
INTRODUCTION: 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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".