Abstract
Complex regional pain syndrome (CRPS) is a chronic pain disorder characterized by severe, disproportionate pain relative to an inciting event. The disorder's pathophysiology is complex, involving both central and peripheral nervous system alterations, alongside genetic, inflammatory, and psychological factors. Using data from TriNetX, this study investigated the impact of analgesic and adjuvant therapies on psychiatric outcomes in CRPS patients. The analysis included 1,029 patients treated with non-opioid versus opioid analgesics and those using antidepressants versus anticonvulsants. Results revealed no significant differences in major depressive disorder (MDD), anxiety, suicidal ideation, or post-traumatic stress disorder (PTSD) between opioid and non-opioid analgesic groups. However, opioid analgesic was associated with a lower risk of behavioral disorders due to psychoactive substance use disorder (0.732; 95% confidence interval [CI] 0.555-0.899). Anticonvulsants, compared to antidepressants, were linked to significantly higher odds and hazards of psychiatric comorbidities: depression (odds ratio [OR] 5.475), anxiety (OR 1.87), PTSD (OR 1.551), and suicidal ideation (OR 2.718). Hazard ratios also showed higher risks for antidepressants in depression, anxiety, and PTSD. These findings highlight the risks and benefits associated with opioid analgesics and the potential therapeutic effects of antidepressants in patients with CRPS. Treatment should consider physiological and psychiatric symptoms, as both are impactful on pain management.