• Angela Mailis-Gagnon, Keith Nicholson, Daniel Blumberger, and Mateusz Zurowski.
• Comprehensive Pain Program, Toronto Western Hospital, Toronto, Ontario, Canada. angela.mailis@uhn.on.ca
• Clin J Pain. 2008 Feb 1;24(2):176-85.

IntroductionAlthough 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.MethodsRetrospective chart review was conducted for all cases referred as "neuropathic pain" to a comprehensive pain clinic over a period of 2 years.ResultsOut 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.ConclusionsThis 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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