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Chronic Post-Ischemia Pain Model for Complex Regional Pain Syndrome Type-I in Rats
Published on: January 21, 2020
A descriptive study on the treatment of pediatric CRPS in the Nordic countries and Germany
Johanna Broman1,2, Cathrin Weigel3, Ludwig Hellmundt4
1Department of Clinical Sciences Lund/Helsingborg, Anesthesiology and Intensive Care Medicine Lund University Lund Sweden.
Insights
Pediatric complex regional pain syndrome (pCRPS) treatment centers in Nordic countries and Germany are scarce. Most centers treat few children with pCRPS and lack established guidelines, highlighting a need for improved resources and standardized care.
Area of Science:
- Pediatric Pain Management
- Neurology
- Rehabilitation Medicine
Background:
- Pediatric complex regional pain syndrome (pCRPS) is a rare, debilitating condition following trauma.
- Diagnosis and treatment necessitate specialized multidisciplinary expertise.
- Effective management focuses on pain reduction and functional improvement, distinct from adult CRPS protocols.
Purpose of the Study:
- To identify and characterize pain centers in Nordic countries and Germany treating pediatric patients with pCRPS.
- To describe the current treatment strategies employed for pCRPS in these regions.
Main Methods:
- A cross-sectional survey was conducted.
- Centers and healthcare professionals were identified via internet searches, phone, and email.
- A standardized electronic questionnaire gathered data on patient volume, treatment approaches, and guideline adherence.
Main Results:
- 28 participants from 24 centers across Germany and Nordic countries were identified.
- Most centers treated a low volume of pCRPS patients annually (1-5 children/year), with only one treating over 20.
- Physiotherapy (74%) and psychological therapy (57% always offered) were common, while guidelines were followed by only 32% and pharmacological treatments were rarely used.
Conclusions:
- Treatment resources for pCRPS in the studied regions are limited.
- A lack of established guidelines and low patient volume in most centers pose challenges.
- Multidisciplinary approaches combining physiotherapy and psychotherapy are prevalent, but overall care requires enhancement.
Abstract:
Pediatric complex regional pain syndrome (pCRPS) is a rare, painful state that often occurs as a complication following physical trauma. Diagnosis and treatment require specialist expertise in a multidisciplinary setting. Treatment is focused on pain reduction and improvement in function, which differs from the treatment of adult CRPS. We performed a cross-sectional survey with the aim of identifying pain centers in the Nordic countries and Germany that specialized in treating children with pain, especially pCRPS, and sought to describe their treatment strategies. Centers and health-care professionals working with children experiencing chronic pain were identified using internet search engines, phones, or e-mail. A standardized set of questions and an electronic questionnaire were answered by the participants. A total of 28 participants were identified in 24 centers, which were involved with patients having pCRPS (Germany: 7, Norway: 7, Sweden: 5, Finland: 5, Denmark: 3, and Island: 1). One center in Germany treated more than 20 patients per year. Half of the identified centers (n = 12) treated between 1 and 5 children with pCRPS per year. Guidelines for treating pCRPS were reportedly followed by 9/28 responders (32%), and physiotherapy was reported to be part of the treatment routine in most centers (74%). Interventional anesthesia was rarely used. Psychological therapy: 57% answered that it was always offered, 30% replied that it was proffered in most cases, and 13% responded that it was recommended in only a few patients. Pharmacological treatments were not commonly used. Treatment resources for pCRPS are scarce in the Nordic countries and Germany. Most centers treated very few children with pCRPS and did not have established guidelines. A multidisciplinary approach was used by many centers, most often combining physiotherapy and psychotherapy, and less commonly pharmacological treatment. The difficulties in diagnosing pCRPS and finding official referral units are unfortunate, considering the potentially favorable outcome with adequate treatment.
