Chronic Pains Associated with Positive and Negative Sensory, Motor, and Vasomotor Manifestations: CPSMV (RSD;CRPS?). Heterogeneous Somatic Versus Psychopathologic Origins

by José L. Ochoa, MD, PhD, DSc

Published: 14 August 1997

Patients complaining of chronic pains associated with assorted positive or negative sensory, motor, and vasomotor symptoms or signs may harbor any variety of legitimate primary diseases of the soma or the psyche and may also be malingerers. Regrettably, these patients are typically misperceived as constituting a homogeneous population in terms of their pathogenesis and continue to be labeled with any of several quasiequivalent traditional terms, such as causalgia, reflex sympathetic dystrophy, sympathetically maintained pains, algodystrophy, CRPS or neuropathic pains. These terms foster the false assumption that the mechanistic basis of the symptom complex is understood, solitary, and unique. Such fallacy breeds mismanagement and iatrogenesis. A proper understanding of these patients first requires the cancellation of those diagnostic terms that misleadingly imply specific causality. Next, it is essential that both clinician and scientist become aware that CPSMV patients represent a heterogeneous group whose differential diagnosis is usually bypassed; and that, often, the primary mechanism leading to chronic pain and the associated psychophysical sensory, motor, and even objective vasomotor manifestations is psychogenic.

Keywords: Pain, Neuropathy, Pseudoneuropathy, RSD, Pseudoscience, Somatization, Iatrogenesis