Exploring the Psychiatric Burden of Complex Regional Pain Syndrome Type I After Long-bone Fractures

Introduction: Psychiatric disorders are known risk factors for complex regional pain syndrome (CRPS), but little is known about psychiatric outcomes after CRPS type I. This study investigates the development of psychiatric conditions after CRPS type I diagnosis in patients with surgically treated long-bone fractures. Methods: A retrospective, propensity-matched cohort study was conducted using the TriNetX US Collaborative Network. Adults with surgically treated long-bone fractures from 2014 to 2023 were included. Patients with prior psychiatric diagnoses or selective serotonin reuptake inhibitor use were excluded. Those diagnosed with CRPS type I within 1 year were matched 1:1 to control subjects without CRPS. Psychiatric outcomes were assessed over 2 years. Results: Among 2,540 matched pairs, patients with CRPS had higher risks of anxiety (39% vs. 23%, RR 1.7), mood disorders (35% vs. 22%, RR 1.6), insomnia (24% vs. 13%, RR 1.8), and substance use disorders (33% vs. 24%, RR 1.4). No notable differences were found in psychosis or suicide attempts. Conclusion: CRPS type I is linked to increased psychiatric morbidity, highlighting the need for proactive mental health screening and care. KEY WORDS: CRPS, Long-bone fracture, Psychiatric sequelae. Level of Evidence: Level III.