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Characterisation and non-pharmacological treatment of Complex Regional Pain Syndrome in under-18-year-olds: a scoping
Mahira Budhraja1, Ryan Purvis2, Katrina Tang2
1School of Health and Social Wellbeing, Centre for Health and Clinical Research, University of the West of England, Glenside Campus, Blackberry Hill, Bristol, BS16 1DD, UK. mahira.budhraja@uwe.ac.uk.
Insights
This review highlights that severe pain disproportionate to the inciting event is the primary symptom of Complex Regional Pain Syndrome (CRPS) in children. Significant research gaps exist in validated diagnostic criteria and understanding treatment efficacy for pediatric CRPS.
Area of Science:
- Pediatric Pain Management
- Neurology
- Rehabilitation Medicine
Background:
- Complex Regional Pain Syndrome (CRPS) is a challenging pediatric pain condition that is poorly understood, with no established diagnostic criteria or treatment guidelines.
- Current literature lacks comprehensive documentation on the presentation, characteristics, and non-pharmacological management of CRPS in individuals under 18.
Purpose of the Study:
- To conduct a scoping review of published literature on the presentation, characteristics, and non-pharmacological treatments for pediatric CRPS.
- To identify and synthesize existing research on CRPS in children and adolescents.
- To highlight critical gaps in the evidence base and propose future research directions using the PAGER framework.
Main Methods:
- A systematic literature search was performed across five databases (AMED, CINAHL+, EMBASE, EBSCO, MEDLINE) using relevant keywords.
- Studies were screened against eligibility criteria, and data from included articles were narratively synthesized.
- The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines were followed.
Main Results:
- Thirty articles were included, revealing extreme pain, allodynia, and nail changes as primary symptoms in pediatric CRPS.
- Commonly employed diagnostic methods included the Budapest criteria, radiography, bone scans, and laboratory tests.
- Non-pharmacological interventions such as physiotherapy, hydrotherapy, desensitization, and cognitive behavioral therapy were frequently utilized.
Conclusions:
- Severe pain disproportionate to the inciting event is the most common symptom of pediatric CRPS.
- Critical knowledge gaps were identified, including the absence of age-appropriate validated diagnostic criteria and a lack of research on the lived experience, impact, and treatment efficacy of CRPS in children.
- Urgent recommendations are made for future research and clinical practice to address these identified gaps.
Abstract:
The aim of this review was to explore the published literature describing the presentation, characteristics, and non-pharmacological treatments of Complex Regional Pain Syndrome (CRPS) in under 18-year-olds. This scoping review was conducted in line with the Preferred Reporting Guidelines for Scoping Reviews (PRISMA-ScR). Five online databases (AMED, CINAHL + , EMBASE, EBSCO, and MEDLINE) were systematically searched with identified key terms for relevant records and screened against the eligibility criteria. Extracted data from the included studies informed a narrative synthesis. The PAGER framework was used to succinctly present gaps in the field and recommend future directions for research. Online searches yielded 140 articles. Following screening, 30 articles were included for review. Findings suggest primary symptoms included extreme pain, allodynia, and nail changes. The Budapest criteria, radiography, bone scans and laboratory examinations were commonly used diagnostic methods. Various non-pharmacological interventions were used, such as physiotherapy (home exercise), hydrotherapy, desensitisation, and cognitive behavioural therapy.
Conclusion:
The most common symptom in children is severe pain that is disproportionate to the inciting event. Critical gaps in the evidence base such as the absence of age appropriate, validated diagnostic criteria, lack of research understanding the lived experience and impact of the condition or exploring treatment efficacy, were identified as knowledge gaps within the field.
What Is Known:
• Complex Regional Pain Syndrome is a difficult to diagnose and hard to treat pain condition. Among children, it is not well documented or understood, there are no agreed diagnostic criteria or treatment guidelines.
What Is New:
• This scoping review summarises and presents the published research regarding presentation, diagnosis and non-pharmacological treatment of paediatric CRPS. • Issues relating to the use of treatments lacking demonstrable efficacy and the need for quick and reliable diagnoses are discussed. • Using the PAGER Framework, this review exposes critical gaps in both research (the lack of research around condition experience and treatment efficacy) and practice (the lack of validated diagnostic criteria and treatment pathways) outlining clear and urgent recommendations.
