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Published on: January 21, 2020
Management of pediatric patients with complex regional pain syndrome
1Mayo Clinic Mayo Eugenio Litta Children's Hospital, Rochester, MN 55902, USA. nelsondv@shsu.edu
Insights
Complex Regional Pain Syndrome (CRPS) in children shows few differences from adults, with a strong preference for lower limb cases. Early physical therapy and multidisciplinary approaches are key to successful treatment and rehabilitation.
Area of Science:
- Pediatric Pain Management
- Neurology
- Rehabilitation Medicine
Background:
- Complex Regional Pain Syndrome (CRPS) is a condition affecting children, with historical assumptions of significant differences from adult presentations.
- A notable observation in pediatric CRPS is the higher incidence of lower extremity involvement.
Purpose of the Study:
- To review current knowledge on the diagnosis and management of CRPS in pediatric populations.
- To compare pediatric CRPS characteristics and treatment responses with those observed in adults.
Main Methods:
- Systematic review of existing literature on pediatric CRPS.
- Analysis of diagnostic criteria, treatment modalities, and outcome studies.
Main Results:
- Pediatric CRPS exhibits minimal intrinsic differences compared to adult CRPS, apart from a higher prevalence in the lower extremities.
- Evidence supporting psychological factors as primary causes is limited.
- Children generally respond well to physical therapy, with multidisciplinary approaches showing promising outcomes.
- Recurrence rates may be higher in children, but re-treatment is often effective.
Conclusions:
- The course of CRPS in children may appear milder due to greater engagement in therapy, rather than inherent disease differences.
- Treatment approaches for pediatric CRPS largely mirror adult strategies, with a cautious use of medications and invasive procedures.
- Further rigorous research is needed to optimize the rehabilitation of children with CRPS.
Abstract:
This review summarizes current information about diagnosis and treatment of complex regional pain syndrome (CRPS) in children. Although it has been widely held that CRPS in children is intrinsically different from adults, there appear to be relatively few differences. However, there is a marked preponderance of lower extremity cases in children. Historically, psychological factors have been invoked to explain the genesis and persistence of CRPS in children, but the evidence is not compelling. Treatment outcome studies are limited but indicate that children generally respond to a primary focus on physical therapy. Multidisciplinary treatment reports are particularly encouraging. The general perception that children have a milder course may relate to the potentially greater willingness of children to actively participate in appropriately targeted treatment rather than to innate differences in the disease process itself. Recurrence rates appear higher than in adults, but response to reinitiation of treatment seems to proceed efficiently. Clinical judgment dictates the extent of medication or interventional therapy added to the treatment to facilitate rehabilitation. In many ways, the approach to the treatment of children mirrors that of adults, with perhaps greater restraint in the use of medications and invasive procedures. The rehabilitation of children with CRPS, like that of adults with CRPS, needs further rigorous investigation.
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