{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T07:20:34Z","timestamp":1782285634815,"version":"3.54.5"},"reference-count":47,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2025,3,28]],"date-time":"2025-03-28T00:00:00Z","timestamp":1743120000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004359","name":"Vetenskapsr\u00e5det","doi-asserted-by":"publisher","award":["2021-01942"],"award-info":[{"award-number":["2021-01942"]}],"id":[{"id":"10.13039\/501100004359","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100008550","name":"Diabetesfonden","doi-asserted-by":"publisher","award":["DIA2020-492"],"award-info":[{"award-number":["DIA2020-492"]}],"id":[{"id":"10.13039\/501100008550","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100011077","name":"Sk\u00e5nes universitetssjukhus","doi-asserted-by":"publisher","award":["2022-974"],"award-info":[{"award-number":["2022-974"]}],"id":[{"id":"10.13039\/501100011077","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100016670","name":"Region \u00d6sterg\u00f6tland","doi-asserted-by":"publisher","award":["ALF Grants R\u00d6978765"],"award-info":[{"award-number":["ALF Grants R\u00d6978765"]}],"id":[{"id":"10.13039\/100016670","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100016670","name":"Region \u00d6sterg\u00f6tland","doi-asserted-by":"publisher","award":["ALF Grants R\u00d6985138"],"award-info":[{"award-number":["ALF Grants R\u00d6985138"]}],"id":[{"id":"10.13039\/100016670","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100011077","name":"Sk\u00e5nes universitetssjukhus","doi-asserted-by":"publisher","award":["ALF Grants 2022-974"],"award-info":[{"award-number":["ALF Grants 2022-974"]}],"id":[{"id":"10.13039\/501100011077","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>The pathophysiology behind Complex Regional Pain Syndrome (CRPS) is not fully understood and associated factors and triggers for developing the condition are debated. We aimed to study such factors and long-term outcome in a descriptive cross-sectional study with a well-defined population with CRPS in the upper limb and related to sex and CRPS type. In retrospectively collected data from medical records, 149 subjects [women n\u2009=\u2009104 (70%); type 1 CRPS, n\u2009=\u2009108 (72%); type 2 CRPS, n\u2009=\u200941 (28%); follow-up time 21 [8-43] months] were identified and analysed (Chi-squared test, Mann-Whitney U-test, and multiple linear regression). A majority were manual workers, and a larger proportion of subjects were smokers and had less post-secondary education than a reference population (p\u2009&lt;\u20090.001 and p\u2009&lt;\u20090.008). Men were younger, more frequently smoked, had higher BMI, and had lower education levels than women (p\u2009=\u20090.044, p\u2009=\u20090.007, p\u2009&lt;\u20090.001, and p\u2009=\u20090.016, respectively). Subjects with CRPS type 2 were younger and had a longer time from symptoms until diagnosis, longer follow-up time, and more follow-up visits, indicating worse outcome (p\u2009=\u20090.016, p\u2009=\u20090.0012, p\u2009=\u20090.003, and p\u2009=\u20090.004, respectively). Among CRPS, 32% had a prior pain disorder and 7% had previously visited a pain management clinic. While there was no significant difference in mental illness occurrence before CRPS diagnosis compared to a reference population, mental illness increased by 76% after diagnosis. Factors such as CRPS type 2, older age, and delayed diagnosis were associated with longer follow-up periods. Additionally, 45% were on sick leave for over 12 months, and 20% were permanently unable to work. Socioeconomic deprivation is an associated factor in developing CRPS, in which a variety of triggers exist. Subjects with CRPS, particularly type 2, are at high risk of severe remaining symptoms, including mental illness and risk of never returning to work.<\/jats:p>","DOI":"10.1371\/journal.pone.0320263","type":"journal-article","created":{"date-parts":[[2025,3,28]],"date-time":"2025-03-28T20:16:38Z","timestamp":1743192998000},"page":"e0320263","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":5,"title":["Associated factors, triggers and long-term outcome in Complex Regional Pain Syndrome (CRPS) in the upper limb \u2013 A descriptive cross-sectional study"],"prefix":"10.1371","volume":"20","author":[{"given":"Astrid","family":"Parinder","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellen","family":"Lyckeg\u00e5rd Finn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1334-3099","authenticated-orcid":true,"given":"Lars B.","family":"Dahlin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2792-9525","authenticated-orcid":true,"given":"Erika","family":"Nyman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,3,28]]},"reference":[{"issue":"6","key":"pone.0320263.ref001","doi-asserted-by":"crossref","first-page":"e624","DOI":"10.1097\/PR9.0000000000000624","article-title":"Complex regional pain syndrome-up-to-date","volume":"2","author":"F Birklein","year":"2017","journal-title":"Pain Rep"},{"issue":"2","key":"pone.0320263.ref002","doi-asserted-by":"crossref","first-page":"e03329","DOI":"10.1016\/j.heliyon.2020.e03329","article-title":"A medical mystery of complex regional pain syndrome","volume":"6","author":"J Eldufani","year":"2020","journal-title":"Heliyon"},{"issue":"5","key":"pone.0320263.ref003","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1016\/S1474-4422(24)00076-0","article-title":"Complex regional pain syndrome: advances in epidemiology, pathophysiology, diagnosis, and treatment","volume":"23","author":"MC Ferraro","year":"2024","journal-title":"Lancet Neurol"},{"issue":"6","key":"pone.0320263.ref004","doi-asserted-by":"crossref","first-page":"1203","DOI":"10.1002\/ejp.1953","article-title":"Complex regional pain syndrome what is the outcome? - a systematic review of the course and impact of CRPS at 12 months from symptom onset and beyond","volume":"26","author":"S Johnson","year":"2022","journal-title":"Eur J Pain"},{"issue":"2","key":"pone.0320263.ref005","doi-asserted-by":"crossref","first-page":"e424","DOI":"10.1016\/j.bja.2019.03.030","article-title":"Complex regional pain syndrome: a narrative review for the practising clinician","volume":"123","author":"H Shim","year":"2019","journal-title":"Br J Anaesth"},{"issue":"2","key":"pone.0320263.ref006","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1016\/j.hcl.2009.11.001","article-title":"Complex regional pain syndrome after hand surgery","volume":"26","author":"Z Li","year":"2010","journal-title":"Hand Clin"},{"issue":"2","key":"pone.0320263.ref007","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1007\/s40122-021-00279-4","article-title":"Complex regional pain syndrome: a comprehensive review","volume":"10","author":"S-S Taylor","year":"2021","journal-title":"Pain Ther"},{"issue":"3","key":"pone.0320263.ref008","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1016\/j.autrev.2013.10.006","article-title":"Complex regional pain syndrome: a comprehensive and critical review","volume":"13","author":"AT Borchers","year":"2014","journal-title":"Autoimmun Rev"},{"issue":"Suppl 1","key":"pone.0320263.ref009","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1093\/pm\/pnac046","article-title":"Complex regional pain syndrome: practical diagnostic and treatment guidelines, 5th edition","volume":"23","author":"RN Harden","year":"2022","journal-title":"Pain Med"},{"issue":"9","key":"pone.0320263.ref010","doi-asserted-by":"crossref","first-page":"2346","DOI":"10.1097\/j.pain.0000000000002245","article-title":"The Valencia consensus-based adaptation of the IASP complex regional pain syndrome diagnostic criteria","volume":"162","author":"A Goebel","year":"2021","journal-title":"Pain"},{"issue":"6","key":"pone.0320263.ref011","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1016\/j.jpain.2018.01.004","article-title":"Signs and symptoms in 1,043 patients with complex regional pain syndrome","volume":"19","author":"S Ott","year":"2018","journal-title":"J Pain"},{"issue":"2","key":"pone.0320263.ref012","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1177\/20494637211041935","article-title":"Decreasing incidence of complex regional pain syndrome in the Netherlands: a retrospective multicenter study","volume":"16","author":"TD Groenveld","year":"2022","journal-title":"Br J Pain"},{"issue":"1\u20132","key":"pone.0320263.ref013","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1016\/S0304-3959(03)00313-0","article-title":"Questions concerning the incidence and prevalence of complex regional pain syndrome type I (RSD)","volume":"106","author":"GJ Bennett","year":"2003","journal-title":"Pain"},{"issue":"1\u20132","key":"pone.0320263.ref014","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/j.pain.2006.09.008","article-title":"The incidence of complex regional pain syndrome: a population-based study","volume":"129","author":"M de Mos","year":"2007","journal-title":"Pain"},{"issue":"1\u20132","key":"pone.0320263.ref015","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1016\/S0304-3959(03)00065-4","article-title":"Complex regional pain syndrome type I: incidence and prevalence in Olmsted county, a population-based study","volume":"103","author":"P Sandroni","year":"2003","journal-title":"Pain"},{"issue":"3","key":"pone.0320263.ref016","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1097\/ALN.0b013e3181e3db38","article-title":"An update on the pathophysiology of complex regional pain syndrome","volume":"113","author":"S Bruehl","year":"2010","journal-title":"Anesthesiology"},{"issue":"1","key":"pone.0320263.ref017","doi-asserted-by":"crossref","first-page":"4871","DOI":"10.1038\/s41598-019-41152-x","article-title":"Incidence of and risk factors for complex regional pain syndrome type 1 after surgery for distal radius fractures: a population-based study","volume":"9","author":"Y-H Jo","year":"2019","journal-title":"Sci Rep"},{"issue":"2","key":"pone.0320263.ref018","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1016\/j.jht.2017.03.007","article-title":"Risk factors for complex regional pain syndrome in patients with surgically treated traumatic injuries attending hand therapy","volume":"31","author":"S Sava\u015f","year":"2018","journal-title":"J Hand Ther"},{"issue":"11","key":"pone.0320263.ref019","doi-asserted-by":"crossref","first-page":"1270","DOI":"10.1016\/j.jpain.2013.07.004","article-title":"Primary motor cortex function in complex regional pain syndrome: a systematic review and meta-analysis","volume":"14","author":"F Di Pietro","year":"2013","journal-title":"J Pain"},{"issue":"10","key":"pone.0320263.ref020","doi-asserted-by":"crossref","first-page":"1001","DOI":"10.1016\/j.jpain.2013.04.001","article-title":"Primary somatosensory cortex function in complex regional pain syndrome: a systematic review and meta-analysis","volume":"14","author":"F Di Pietro","year":"2013","journal-title":"J Pain"},{"key":"pone.0320263.ref021","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/j.jclinane.2017.03.027","article-title":"Complex regional pain syndrome type 1 predictors - epidemiological perspective from a national database analysis","volume":"39","author":"A Elsharydah","year":"2017","journal-title":"J Clin Anesth"},{"issue":"4","key":"pone.0320263.ref022","doi-asserted-by":"crossref","first-page":"744","DOI":"10.1007\/s11999.0000000000000070","article-title":"Complex regional pain syndrome after distal radius fracture is uncommon and is often associated with fibromyalgia","volume":"476","author":"TJ Crijns","year":"2018","journal-title":"Clin Orthop Relat Res"},{"issue":"5","key":"pone.0320263.ref023","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1038\/nrneurol.2018.20","article-title":"Complex regional pain syndrome - phenotypic characteristics and potential biomarkers","volume":"14","author":"F Birklein","year":"2018","journal-title":"Nat Rev Neurol"},{"issue":"3","key":"pone.0320263.ref024","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1002\/ejp.1900","article-title":"Pain, disability, and lifestyle: Patients with complex regional pain syndrome compared to chronic musculoskeletal pain-A retrospective analysis","volume":"26","author":"G Kindl","year":"2022","journal-title":"Eur J Pain"},{"key":"pone.0320263.ref025","first-page":"956539","article-title":"Potential risk factors for the onset of complex regional pain syndrome type 1: a systematic literature review","author":"T Pons","year":"2015","journal-title":"Anesthesiol Res Pract"},{"issue":"4","key":"pone.0320263.ref026","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1097\/00002508-199812000-00005","article-title":"Personality assessment of patients with complex regional pain syndrome type I","volume":"14","author":"DA Monti","year":"1998","journal-title":"Clin J Pain"},{"issue":"9","key":"pone.0320263.ref027","doi-asserted-by":"crossref","first-page":"971","DOI":"10.1016\/j.ejpain.2011.02.008","article-title":"The association between psychological factors and the development of complex regional pain syndrome type 1 (CRPS1) \u2013 a prospective multicenter study","volume":"15","author":"A Beerthuizen","year":"2011","journal-title":"Eur J Pain"},{"issue":"8","key":"pone.0320263.ref028","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1097\/AJP.0000000000000007","article-title":"Relationships between psychological factors, pain, and disability in complex regional pain syndrome and low back pain","volume":"30","author":"DJ Bean","year":"2014","journal-title":"Clin J Pain"},{"issue":"3","key":"pone.0320263.ref029","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1002\/ejp.2068","article-title":"Biological and psychological early prognostic factors in complex regional pain syndrome: a systematic review","volume":"27","author":"M-H Louis","year":"2023","journal-title":"Eur J Pain"},{"key":"pone.0320263.ref030","doi-asserted-by":"crossref","first-page":"3235","DOI":"10.2147\/JPR.S278614","article-title":"Psychiatric comorbidity and complex regional pain syndrome through the lens of the biopsychosocial model: a comparative study","volume":"13","author":"HP Duong","year":"2020","journal-title":"J Pain Res"},{"issue":"7","key":"pone.0320263.ref031","doi-asserted-by":"crossref","first-page":"1304","DOI":"10.1002\/ejp.1218","article-title":"Comorbidity between pain and mental illness - evidence of a bidirectional relationship","volume":"22","author":"E Bondesson","year":"2018","journal-title":"Eur J Pain"},{"issue":"3","key":"pone.0320263.ref032","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1007\/s11481-012-9392-x","article-title":"Neuroinflammation, neuroautoimmunity, and the co-morbidities of complex regional pain syndrome","volume":"8","author":"MS Cooper","year":"2013","journal-title":"J Neuroimmune Pharmacol"},{"issue":"3","key":"pone.0320263.ref033","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1111\/papr.12610","article-title":"Risk factors for post-treatment complex regional pain syndrome (CRPS): an analysis of 647 cases of CRPS from the danish patient compensation association","volume":"18","author":"PB Petersen","year":"2018","journal-title":"Pain Pract"},{"issue":"2","key":"pone.0320263.ref034","doi-asserted-by":"crossref","first-page":"219","DOI":"10.4103\/0972-2327.150590","article-title":"Comparison of high-resolution sonography and electrophysiology in the diagnosis of carpal tunnel syndrome","volume":"18","author":"MA Kanikannan","year":"2015","journal-title":"Ann Indian Acad Neurol"},{"issue":"1","key":"pone.0320263.ref035","first-page":"555579","article-title":"Risk Factor for complex regional pain syndrome","volume":"2","author":"K Toda","year":"2018","journal-title":"JOJ Orthoped Ortho Surg"},{"key":"pone.0320263.ref036","author":"International Association for the Study of Pain. IASP Taxonomy","year":"2017"},{"key":"pone.0320263.ref037","unstructured":"Folkh\u00e4lsomyndigheten. Daglig tobaksr\u00f6kning. 2022."},{"key":"pone.0320263.ref038","unstructured":"Statistics Sweden (SCB). Antal personer efter region, hush\u00e5llsst\u00e4llning, \u00e5lder, k\u00f6n och \u00e5r. 2022."},{"key":"pone.0320263.ref039","unstructured":"Regionfakta. Utbildningsniv\u00e5 befolkning 25-64 \u00e5r. 2022."},{"key":"pone.0320263.ref040","unstructured":"Folkh\u00e4lsomyndigheten. Psykisk h\u00e4lsa (sj\u00e4lvrapporterat) efter \u00e5lder, k\u00f6n och \u00e5r. Andel (procent). 2022."},{"key":"pone.0320263.ref041","doi-asserted-by":"crossref","first-page":"16069","DOI":"10.1038\/nrdp.2016.69","article-title":"Postmenopausal osteoporosis","volume":"2","author":"R Eastell","year":"2016","journal-title":"Nat Rev Dis Primers"},{"issue":"2","key":"pone.0320263.ref042","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1016\/j.pain.2008.07.002","article-title":"Medical history and the onset of complex regional pain syndrome (CRPS)","volume":"139","author":"M de Mos","year":"2008","journal-title":"Pain"},{"issue":"11","key":"pone.0320263.ref043","doi-asserted-by":"crossref","first-page":"2310","DOI":"10.1097\/j.pain.0000000000000282","article-title":"Do psychological factors influence recovery from complex regional pain syndrome type 1? a prospective study","volume":"156","author":"DJ Bean","year":"2015","journal-title":"Pain"},{"issue":"1\u20133","key":"pone.0320263.ref044","first-page":"56","article-title":"Managing psychiatric symptoms in patients with complex regional pain syndrome","volume":"19","author":"JR Scarff","year":"2022","journal-title":"Innov Clin Neurosci"},{"key":"pone.0320263.ref045","first-page":"2","article-title":"Complex regional pain syndrome: a recent update","volume":"5","author":"EL Goh","year":"2017","journal-title":"Burns Trauma"},{"issue":"5","key":"pone.0320263.ref046","first-page":"CD010853","article-title":"Physiotherapy for pain and disability in adults with complex regional pain syndrome (CRPS) types I and II","volume":"5","author":"KM Smart","year":"2022","journal-title":"Cochrane Database Syst Rev"},{"key":"pone.0320263.ref047","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1186\/1471-2474-11-286","article-title":"Outcome and clinical changes in patients 3, 6, 12 months after a severe or major hand injury--can sense of coherence be an indicator for rehabilitation focus?","volume":"11","author":"RI Cederlund","year":"2010","journal-title":"BMC Musculoskelet Disord"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0320263","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,28]],"date-time":"2025-03-28T20:18:02Z","timestamp":1743193082000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0320263"}},"subtitle":[],"editor":[{"given":"Nan","family":"Jiang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,3,28]]},"references-count":47,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,3,28]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0320263","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,28]]}}}