MedifocusHealth

Within the first 6-8 weeks of RSD, patients may heal spontaneously or respond quickly to therapy so they may not need to focus as intently on psychological intervention since they also may not have developed habits such as disuse of the arm or bracing the arm to protect it from injury or pain.

Psychological Assessment

The key psychological issues that will impact treatment and should, therefore, be evaluated include:

• Presence of comorbid psychiatric disorders that are common in RSD patients, such as major depression, panic disorder, generalized anxiety disorder, or posttraumatic stress disorder. Estimates are that up to 1 in 4 patients with RSD may suffer from one of these disorders, with depression being the most common comorbidity. These conditions impact significantly on the treatment of RSD due to the resulting lack of motivation - a key ingredient for self management skills.
• Identification of the areas of stress in the patient's life
• The response of close family members to the patient with RSD
• How the patient responds to pain, such as fear of pain, level of bracing or disuse, guarding the limb against allodynia, and overall functioning

As these issues are evaluated during the psychological assessment, the health care professional can communicate the relevant issues to the various members of the rehabilitation team and each can integrate their aspect of therapy to address these issues.

Pain Management Skills

Many patients harbor cognitive misconceptions regarding pain and progression in RSD. Common false assumptions include:

• RSD is progressive, spreads throughout the body, and is untreatable
• If there is pain, tissue in the extremity has been damaged and the limb should not be used
• Treatments that cause pain should not be pursued, rather they should be offered interventional therapies which provide a "quick fix".

One of the most widely used techniques for teaching patients how to stay "in control" of their RSD and develop skills to manage their pain is cognitive behavioral therapy (CBT). Cognitive behavior therapy focuses on changing an individual's cognitive patterns (thoughts) as a means of changing their behavior or emotional state. The premise in CBT is that a person's own thoughts cause their feelings and behaviors, rather than external factors such as people or events. With CBT a person is taught to change the way they think in order to feel better even if the situation around them does not change. For example, in the face of fear of pain or using a limb which they have been not using (bracing or guarding from pain), the patient would be taught to say to himself or herself "I can handle this" or "I won't know if I can handle this until I try". They can test the cognitive skills they have learned when going to physical, occupational, or recreational therapy. The new cognitive skills can also be practiced at home over and over giving the patient the feeling of success by seeing how they can begin to make small steps of improvement that they could not do before.