[Psychosomatic correlations of sympathetic reflex dystrophy (Sudeck's disease). Review of the literature and initial clinical results].

The present state of the art in psychosomatic research on reflex sympathetic dystrophy or Sudeck's atrophy (also known as Sudeck's disease) is reviewed. The survey confirms the impression prevailing with surgeons and orthopaedists that patients suffering from this disease are "psychically peculiar", i.e. they appear strange or odd. Psychometric examinations show that they suffer from enhanced anxiety, are emotionally rather unstable and display a tendency to depressiveness associated with a marked self-esteem rating problem complex. Basing upon these criteria the occurrence of reflex sympathetic dystrophy in the postoperative course of patients with Dupuytren's contracture could be correctly predicted in 43 of 47 patients, the remaining 4 patients being forecast with a false-positive prediction (Zachariae 1964). Studies on Children with reflex sympathetic dystrophy likewise confirmed these characteristic features. In a study of our own we examined in 12 patients their biographical development as well as life events that had happened 6 months before onset of the disease. We obtained a surprisingly uniform result: In all patients we found that at least one or in most cases several severely stressful life events had occurred; all patients had been suffering from chronic headache and/or pain in the lumbar vertebral column for many years; and all of them had shown signs in the course of their development in childhood and adolescence that have been described by Engel as "pain proneness". Over and above this, the anamnesis of most patients revealed other psychogenic and psychosomatic diseases or signs and symptoms. The case reports of all the 12 patients served as basis for initial approaches to a psychosomatic disease concept of reflex sympathetic dystrophy.