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Cutaneous sensory abnormalities in children and adolescents with complex regional pain syndromes

Navil F Sethna1, Petra M Meier, David Zurakowski

  • 1Department of Anesthesiology, Perioperative and Pain Medicine, Children's Hospital, Harvard Medical School Boston, MA 02115, USA. navil.sethna@childrens.harvard.edu

Pain
|March 3, 2007
PubMed

Insights

Pediatric complex regional pain syndrome (CRPS) shows distinct sensory dysfunction from adults, with cold allodynia being a common finding. These differences suggest a potentially central origin for pain in children.

Area of Science:

  • Neurology
  • Pain Medicine
  • Pediatrics

Background:

  • Complex regional pain syndromes (CRPS) are increasingly diagnosed in children, but adult-based diagnostic criteria may not fully apply.
  • Pediatric CRPS exhibits unique characteristics compared to adult presentations.

Purpose of the Study:

  • To characterize sensory dysfunction in pediatric patients with CRPS using quantitative sensory testing (QST).
  • To compare QST findings in children with CRPS against healthy pediatric controls.

Main Methods:

  • Standardized neurological examination and QST were performed on 42 pediatric patients with unilateral lower extremity CRPS.
  • QST parameters were compared to age- and sex-matched healthy pediatric control data.

Main Results:

  • Most QST parameters did not significantly differ between pediatric CRPS patients and controls, except for cold and heat pain detection thresholds.
  • Allodynia to cold and/or heat was present in 21 patients, with cold allodynia being the most frequent abnormality.
  • A significant correlation was found between mechanical dynamic allodynia and allodynia to punctate temporal summation.

Conclusions:

  • Pediatric CRPS demonstrates specific sensory deficits, notably cold allodynia, differing from adult CRPS.
  • The varied combinations of thermal and mechanical sensory abnormalities suggest complex pain mechanisms.
  • A central origin is likely for pain pathogenesis in the majority of these pediatric CRPS patients.

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