Scandinavian journal of pain
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While lower socioeconomic status increases individual's risk for chronic conditions, little is known about how long-term social assistance recipients (LTRs) with multiple chronic health problems experience chronic pain and/or psychological distress. Social assistance is the last safety net in the Norwegian welfare system and individuals have a legal right to economic assistance if they are unable to support themselves or are entitled to other types of benefits. The purposes of this study were to determine the co-occurrence of both chronic pain and psychological distress and to evaluate for differences in demographic and social characteristics, as well as health-related quality of life, among LTRs. ⋯ Co-occurrence of chronic pain and psychological distress is common in LTRs and problems in early life are associated with the co-occurrence of chronic pain and psychological distress in adult life. Although this study cannot assign a clear direction or causality to the association between social and demographic characteristics and chronic pain and psychological distress, the findings when examining LTRs' problems in childhood before the age of 16, indicated that incidents in early life create a probability of chronic pain and psychological distress in the adult life of the individuals. Further studies should use life course studies and longitudinal data in to investigate these important questions in LTRs.
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Complex regional pain syndrome (CRPS) is a serious and disabling chronic pain condition, usually occurring in a limb. There are two main types, CRPS 1 with no definite nerve lesion and CRPS 2 with an identified nerve lesion. CRPS 1 and 2 may occur following an injury (frequently following fractures), surgery or without known cause. An early diagnosis and start of adequate treatment is considered desirable for patients with CRPS. From the clinical experience of the principal investigator, it became apparent that CRPS often remained undiagnosed and that the clinical conditions of many patients seemed to be worsened following orthopedic surgery subsequent to the initial eliciting event. The aim of the present retrospective study of 55 patients, all diagnosed with either CRPS 1 or 2, was to evaluate the time from injury until diagnosis of CRPS and the effect on pain of orthopedic surgical intervention subsequent to the original injury/surgery. ⋯ A mean time delay of 3.9 years before diagnosis of CRPS is unacceptable. A lack of attention to more subtle signs of autonomic dysfunction may be an important contributing factor for the missing CRPS diagnosis, in particular serious in patients reporting worsening of pain following subsequent orthopedic surgery. It is strongly recommended to consider the diagnosis of CRPS in all patients with a long-lasting pain condition. We emphasize that the present report is not meant as criticism to orthopedic surgical practice, but as a discussion for a hopefully increased awareness and understanding of this disabling pain condition.