Complex Regional Pain Syndrome in Children: a Multidisciplinary Approach and Invasive Techniques for the Management of Nonresponders

Abstract

Complex regional pain syndrome (CRPS) is multifactorial condition with complex pathogenesis characterized by spontaneous or stimulus-induced pain that is disproportionate to the inciting event. It is also commonly accompanied by a myriad of autonomic and motor disturbances in highly variable combinations. This condition has been underreported in children until recently. Consequently, the management of CRPS in the pediatric population presents an even greater challenge than in adults, partly because there is a lack of clinical data concerning the efficacy of the diverse treatment methods available, and partly because successful treatment of CRPS involves a multidisciplinary approach. In this retrospective case series, a multidisciplinary management plan is presented in 10 children for whom the standard noninvasive treatment was unsuccessful. Within this management plan, novel drugs were included such as the capsaicin 8% patch, in addition to invasive techniques in patients who did not respond to noninvasive therapies.

Complex Regional Pain Syndrome in children and adolescents

“…La prise en charge a pour objectif le retour à une qualité de vie satisfaisante par la gestion de la douleur et la récupération de la mobilité du membre 2 . Elle nécessite une approche biopsychosociale par une équipe multidisciplinaire 2,8,18,21,22 . Le modèle biopsychosocial prend en compte l'ensemble des facteurs psychologiques, sociaux et biologiques des pathologies 23 .…”

“…Il existe des preuves anecdotiques de l'efficacité de la Lidocaïne 5 % transdermique dans le traitement des douleurs neuropathiques chez l'enfant. La compliance est limitée dans le SDRC au vu d'un inconfort/douleur lors de la pose du patch en raison de l'allodynie 26 en addition aux techniques invasives, chez des patients réfractaires aux traitements habituels 21 .…”

A descriptive study on the treatment of pediatric CRPS in the Nordic countries and Germany

“…To the best of our knowledge, no randomized controlled trials have compared the conservative and invasive management strategies in this particular group of patients. 8,14 This study has some limitations. First, the questionnaire used in the study was author-developed, and as the authors were anesthesiologists, Note: Highlighted text involves general questions asked.…”

Spinal Cord Stimulation Improves Functional Outcomes in Children With Complex Regional Pain Syndrome: Case Presentation and Review of the Literature

“…Pediatric cases reported in the literature are of great heterogeneity, with highly variable characteristics, treatment approaches preceding SCS device implantation, and outcome measures. Table 2 summarizes the available literature for SCS in children with CRPS 14–21 . There is no level I evidence and limited level III evidence supporting the use of SCS for CRPS in pediatric patients.…”

“…On follow‐up, none of the patients reported being on oral medications. Another retrospective series in 2015 had 3 pediatric patients with CRPS undergoing implantation of an SCS device following failure of a fixed treatment protocol, and all reported significant improvement or resolution of CRPS symptoms, improved quality of life, and reduction or cessation of oral pain medications 17 . A patient reported by Stanton‐Hicks in 2006 15 underwent SCS, initially as a temporary trial lead insertion, causing great reduction in symptoms; she was weight bearing, and her foot swelling, allodynia, and discoloration were absent.…”