1
|
Karri J, Palmer JS, Charnay A, Garcia C, Orhurhu V, Shah S, Abd-Elsayed A. Utility of Electrical Neuromodulation for Treating Chronic Pain Syndromes in the Pediatric Setting: A Systematic Review. Neuromodulation 2021; 25:671-679. [PMID: 33556220 DOI: 10.1111/ner.13365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/08/2020] [Accepted: 01/05/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Chronic pain syndromes in children can carry significant threats to psychological well-being, opioid overuse, functional impairments, and severe disability. While several high-level studies, almost exclusively in adults, have demonstrated the utility of implantable electrical neuromodulation systems for treating various chronic pain syndromes, there exists a paucity of pediatric-specific evidence. Unfortunately, evidence and practice patterns established from adults may not be fully translatable to children given differences in disease manifestations and anatomical variances. MATERIALS AND METHODS We performed a systematic review using conventional PRISMA methodology to identify studies reporting use of implantable electrical neuromodulation systems in children. The primary outcome parameters collected were analgesic relief and functional benefits. Additionally, previous interventions attempted, neuromodulation parameters, and limitations were collected as reported. RESULTS A total of 11 studies was identified, which described 19 patients who were refractory to multidisciplinary pain management strategies. The cohort was mostly adolescent (18/19), suffered from CRPS (14/19), and received SCS (17/19). Nearly all patients, both those with CRPS (13/14) and non-CRPS conditions (4/4), reported significant pain relief and functional recovery following neuromodulation. There were no severe complications reported; limitations included suboptimal benefit or loss of analgesia (3/19), lead or device revision (3/19), and subcutaneous infection (1/19), all of which were congruent with adult outcomes. CONCLUSION There exist children with chronic pain refractory to standard of care approaches who could be considered for neuromodulation interventions. The existing data, which was limited and from a low tier of evidence, suggest that these interventions are relatively safe and provide meaningful pain reduction and functional improvements. While not previously reported, we recommend careful consideration of the pubertal growth spurt prior to device lead placement-if reasonable and appropriate-given the possibility of inferior lead migration with physiologic growth in patients with SCS devices or foraminal extrusion in patients with dorsal root ganglion stimulation devices.
Collapse
Affiliation(s)
- Jay Karri
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Jeremé Sharíf Palmer
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Aaron Charnay
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Carol Garcia
- Department of Anesthesia, Division of Pain Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Vwaire Orhurhu
- Department of Anesthesia, Division of Pain Medicine, University of Pittsburgh Medical Center, Susquehanna, Williamsport, PA, USA
| | - Shalini Shah
- Department of Anesthesiology & Perioperative Care, Division of Pain Medicine, University of California Irvine, Orange, CA, USA
| | - Alaa Abd-Elsayed
- Department of Anesthesia, Division of Pain Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| |
Collapse
|
2
|
Selent F, Schenk S, Genent D, Wager J, Zernikow B. [Diagnostics and therapy in children and adolescents with chronic pain : Trends in interventions potentially dangerous to health]. Schmerz 2020; 35:83-93. [PMID: 33185762 PMCID: PMC7997831 DOI: 10.1007/s00482-020-00506-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/26/2020] [Accepted: 08/27/2020] [Indexed: 12/19/2022]
Abstract
Hintergrund und Ziel der Arbeit Bei der Behandlung chronischer funktioneller Schmerzen im Kindes- und Jugendalter nimmt international sowohl die Anzahl an diagnostischen und therapeutischen Maßnahmen als auch ihre Invasivität zu. Studienziel ist die Erforschung der vor Beginn einer spezialisierten stationären Schmerztherapie durchgeführten, die pädiatrischen Patienten potenziell gefährdenden Maßnahmen in Deutschland. Material und Methoden In einem retrospektiven Studiendesign wurden Patientenakten eines tertiären Kinderschmerzzentrums der Jahre 2004, 2008, 2012 und 2016 ausgewertet (N = 585). Neben diagnostischen und therapeutischen Maßnahmen wurden primäre Schmerzparameter und Patientencharakteristika erfasst. In einer interdisziplinären Expertenumfrage (N = 13) wurden die Invasivität, das Risiko und die psychische Belastung von Maßnahmen bewertet. Ergebnisse Diagnostische und medikamentöse Maßnahmen nehmen bis 2012 zu. Ab 2012 lässt sich ein abnehmender Trend erkennen (χ2(3) = 11,708; p = 0,008). Die Invasivität (χ2(3) = 13,342; p = 0,004), das Risiko (χ2(3) = 13,135; p = 0,004) und die psychische Belastung (χ2(3) = 14,403; p = 0,002) durchgeführter Maßnahmen zeigen ein gleiches Veränderungsmuster. In der Gesamtstichprobe sind Patienten mit Bauch- oder Gliederschmerzen besonders gefährdet für hoch invasive und sehr risikoreiche Diagnostik. Diskussion Eine Zunahme diagnostischer und therapeutischer Maßnahmen bei funktionellen Schmerzstörungen lässt sich nur bis 2012 beobachten. Bei bestimmten Patientengruppen kommen invasive, risikoreiche und die Psyche stärker belastende Maßnahmen häufiger zur Anwendung. Zusatzmaterial online Die Online-Version dieses Beitrags (10.1007/s00482-020-00506-5) enthält vier weitere Tabellen. Beitrag und Zusatzmaterial stehen Ihnen auf www.springermedizin.de zur Verfügung. Bitte geben Sie dort den Beitragstitel in die Suche ein, das Zusatzmaterial finden Sie beim Beitrag unter „Ergänzende Inhalte“. ![]()
Collapse
Affiliation(s)
- Felix Selent
- Deutsches Kinderschmerzzentrum, Vestische Kinder- und Jugendklinik Datteln, Universität Witten/Herdecke, Dr.-Friedrich-Steiner-Str. 5, 45711, Datteln, Deutschland.,Lehrstuhl für Kinderschmerztherapie und Pädiatrische Palliativmedizin, Fakultät für Gesundheit, Department für Humanmedizin, Universität Witten/Herdecke, Witten, Deutschland
| | - Sabrina Schenk
- Deutsches Kinderschmerzzentrum, Vestische Kinder- und Jugendklinik Datteln, Universität Witten/Herdecke, Dr.-Friedrich-Steiner-Str. 5, 45711, Datteln, Deutschland.,Lehrstuhl für Kinderschmerztherapie und Pädiatrische Palliativmedizin, Fakultät für Gesundheit, Department für Humanmedizin, Universität Witten/Herdecke, Witten, Deutschland
| | - Dunja Genent
- Deutsches Kinderschmerzzentrum, Vestische Kinder- und Jugendklinik Datteln, Universität Witten/Herdecke, Dr.-Friedrich-Steiner-Str. 5, 45711, Datteln, Deutschland.,Lehrstuhl für Kinderschmerztherapie und Pädiatrische Palliativmedizin, Fakultät für Gesundheit, Department für Humanmedizin, Universität Witten/Herdecke, Witten, Deutschland
| | - Julia Wager
- Deutsches Kinderschmerzzentrum, Vestische Kinder- und Jugendklinik Datteln, Universität Witten/Herdecke, Dr.-Friedrich-Steiner-Str. 5, 45711, Datteln, Deutschland.,Lehrstuhl für Kinderschmerztherapie und Pädiatrische Palliativmedizin, Fakultät für Gesundheit, Department für Humanmedizin, Universität Witten/Herdecke, Witten, Deutschland
| | - Boris Zernikow
- Deutsches Kinderschmerzzentrum, Vestische Kinder- und Jugendklinik Datteln, Universität Witten/Herdecke, Dr.-Friedrich-Steiner-Str. 5, 45711, Datteln, Deutschland. .,Lehrstuhl für Kinderschmerztherapie und Pädiatrische Palliativmedizin, Fakultät für Gesundheit, Department für Humanmedizin, Universität Witten/Herdecke, Witten, Deutschland.
| |
Collapse
|
3
|
Abstract
OBJECTIVES Neuromodulation, particularly intrathecal drug delivery systems and spinal cord stimulators (SCSs), can be a valuable tool when treating chronic pain in adults. However, there is a paucity of literature with regard to its use in pediatrics. MATERIALS AND METHODS We present a series of 14 children and adolescents with intractable pain who received a SCS or a pump for the intrathecal delivery of medications between 2010 and 2016 at our institution. RESULTS During the study period, we placed 10 intrathecal pumps and 4 SCSs with an average age of 17 years old. Pain scores significantly improved after the implant (P<0.007) and function improved in 79% of patients. Opioid use was also significantly reduced. Three patients eventually had their device removed due to psychiatric comorbidities. Four patients had complications that were treated without further sequelae. CONCLUSIONS Neuromodulation can offer important options in treating some pediatric chronic pain patients. In-depth knowledge of primary disease and strict patient selection in the context of the patient's social situation is vital to successful treatment.
Collapse
|
4
|
Vega E, Rivera G, Echevarria GC, Prylutskyy Z, Perez J, Ingelmo P. Interventional procedures in children and adolescents with chronic non-cancer pain as part of a multidisciplinary pain treatment program. Paediatr Anaesth 2018; 28:999-1006. [PMID: 30251303 DOI: 10.1111/pan.13494] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 08/15/2018] [Accepted: 08/19/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Interventional procedures are part of multidisciplinary pain treatment programs to treat chronic non-cancer pain conditions in children and adolescents. However, the real benefit of these interventions remains unclear. AIMS The aim of this study was to analyze the potential benefits of the interventional procedures in children and adolescents with chronic non-cancer pain in the setting of a multidisciplinary pain treatment program. METHODS We retrospectively reviewed the charts of 98 children and adolescents receiving 314 diagnostic or therapeutic interventional procedures. We applied the following definitions of efficacy Short-term positive therapeutic effect: block that produced a minimum of 50% reduction in pain intensity for at least 4 weeks. Long-term positive therapeutic effect: a patient with a minimum of 50% reduction in pain intensity for at least 6 months Full recovery: a patient free of pain, not taking analgesics with normal physical and role functioning 6 months after the last procedure. RESULTS Seventy-six of 112 diagnostic blocks (68%) were associated with a 50% reduction in pain intensity for at least 4 weeks after the procedure. One hundred and sixty-six of 202 therapeutics blocks (82%) were associated with a short-term benefit. Seventy-two of 98 patients (73%) referred a 50% reduction in their pain intensity (17%) or had full recovery 6 months after the procedures (56%) and a MPTP. Psychiatric comorbidity and more advanced age were factors associated with failure to respond to interventional procedures. CONCLUSION The use of interventional procedures may represent a valid therapeutic option, associated with positive clinical outcomes within a multidisciplinary program.
Collapse
Affiliation(s)
- Eduardo Vega
- Chronic Pain Service, Department of Anesthesia, McGill University Health Center, Montreal Children's Hospital, Montreal, Québec, Canada.,Department of Anesthesia, School of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
| | - Gonzalo Rivera
- Department of Anesthesia, Clinica Las Condes, Santiago, Chile
| | - Ghislaine C Echevarria
- Department of Anesthesia, Perioperative Care and Pain Medicine, New York University School of Medicine, New York, New York
| | - Zakhar Prylutskyy
- Chronic Pain Service, Department of Anesthesia, McGill University Health Center, Montreal Children's Hospital, Montreal, Québec, Canada
| | - Jordi Perez
- Department of Anesthesia, McGill University Health Center, Montreal General Hospital, Montreal, Québec, Canada.,The Alan Edwards Research Center for Chronic Pain, McGill University, Montreal, Québec, Canada.,Alan Edwards Pain Management Unit, McGill University Health Center, Montreal General Hospital, Montreal, Québec, Canada
| | - Pablo Ingelmo
- Chronic Pain Service, Department of Anesthesia, McGill University Health Center, Montreal Children's Hospital, Montreal, Québec, Canada.,The Alan Edwards Research Center for Chronic Pain, McGill University, Montreal, Québec, Canada.,CIMPARC (Consortium of Multidisciplinary Pain Researchers and Clinicians), Parma, Italy
| |
Collapse
|
5
|
Kaufman EL, Tress J, Sherry DD. Trends in Medicalization of Children with Amplified Musculoskeletal Pain Syndrome. PAIN MEDICINE 2018; 18:825-831. [PMID: 27497319 DOI: 10.1093/pm/pnw188] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Objective The objective of this survey was to describe trends over time in medicalization of children with Amplified Musculoskeletal Pain Syndrome (AMPS). Design A retrospective evaluation was conducted using self-reported data from patients presenting to the pain clinic between January 1, 2008 and December 31, 2014, who were diagnosed with AMPS. Setting and Subjects This was a medical record review of 899 subjects ages 3-20 presenting with Amplified Musculoskeletal Pain Syndrome. Subjects were included if they presented to a single tertiary specialized clinic and obtained a diagnosis of AMPS between January 1, 2008 and December 31, 2014. Methods Information collected from subjects' medical records included: past medications, current outpatient medications, procedures, aids, therapies, studies, professionals seen, hospitalizations, and surgeries. Trends in medicalization were analyzed by year of initial visit. Results Medication use, procedures, studies, therapies, professionals seen, hospitalizations, and surgeries in children with AMPS all increased significantly by year ( P < 0.001). The degree of physical dysfunction, pain, and the use of aids did not significantly increase. Conclusions Children with amplified musculoskeletal pain syndrome are becoming increasingly medicalized. Increased medicalization introduces risk of iatrogenic injury and burdens families with unnecessary medical costs. The significant increase in medicalization of children with AMPS is not related to an increase in patient reported pain, which is evidenced by the lack of significant increase in patients' pain score, pain duration, or functional disability at the time of their initial evaluation.
Collapse
Affiliation(s)
- Elizabeth L Kaufman
- Division of Rheumatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jenna Tress
- Division of Rheumatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - David D Sherry
- Division of Rheumatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| |
Collapse
|
6
|
W Guite J, Sherry DD, Jarvis EW, O Lewen M, Khan S, Wickham Kraemer F. Medication use among pediatric patients with chronic musculoskeletal pain syndromes at initial pain clinic evaluation. Pain Manag 2017; 8:15-25. [PMID: 29199542 DOI: 10.2217/pmt-2017-0034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM To characterize medication use by adolescents with chronic musculoskeletal pain syndromes before an initial multidisciplinary clinic visit. PATIENTS & METHODS A cross-sectional sample of 120 adolescents and parents reported on standardized assessment measures, with medication use data extracted from the medical chart and categorized. RESULTS On average, 3.2 medications were reported; 70% used more than one pain-specific medication including opioids (17%), nonopioids (31%), psychotropics/neuropathics (45%) and other medications (13%). Adolescents with complex regional pain syndrome consistently reported greatest use of opioid, psychotropic/neuropathic and other pain medications. A regression model explained 17% of the variance in pain medication use. Nonpain medication use and disability contributed unique variance - pain duration and intensity did not. CONCLUSION Greater attention to factors contributing to prescriptive practices, medication use and long-term outcomes is warranted.
Collapse
Affiliation(s)
- Jessica W Guite
- Department of Anesthesiology & Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.,Department of Anesthesiology & Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA.,Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT 06032, USA.,Center for Behavioral Health, Connecticut Children's Medical Center, Hartford, CT 06106, USA
| | - David D Sherry
- Department of Rheumatology, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Esther W Jarvis
- Department of Rheumatology, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Margaret O Lewen
- Department of Anesthesiology & Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.,Department of Anesthesiology & Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA.,Department of Rheumatology, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Sarosh Khan
- Center for Behavioral Health, Connecticut Children's Medical Center, Hartford, CT 06106, USA
| | - Francis Wickham Kraemer
- Department of Anesthesiology & Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.,Department of Anesthesiology & Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| |
Collapse
|
7
|
Abstract
AIM Chronic and debilitating pediatric pain has a prevalence of 5% and as such constitutes a considerable health problem. The aim of this article is to provide an overview of current research activities on pediatric pain, available health care for children with chronic pain and education and training programs for health professionals. METHOD This overview is based on the authors' personal experience, information available from medical, research and professional associations, as well as a PubMed literature search for the time period 2012-2015 using "children";"pain" and "Germany" as search terms. RESULTS There are numerous research activities in Germany focusing on the epidemiology, the underlying psychobiological mechanisms and on the multimodal treatment of chronic pediatric pain. This research is internationally widely acknowledged and makes a significant contribution to current developments in pediatric pain research. By contrast, health services and basic science research is clearly lacking in Germany. Moreover, specialized health care for youth with chronic pain is far less institutionalized when compared to adults suffering from chronic pain. Indeed, primary and secondary care services have rarely been studied or even evaluated. CONCLUSION Similar to international trends, research on chronic pediatric pain has also grown and advanced in Germany. Indeed, not only the amount of research has increased but also its scope. Nonetheless, there is clearly a need for more research efforts with regard to the understanding of (pediatric) pain mechanisms, clinical studies and, especially, investigations on health care services. It is particularly important to focus on the implementation, improvement and systematic evaluation of specialized health care services which would be available and accessible for children and adolescents with chronic pain and not be restricted to tertiary care.
Collapse
|
8
|
Cucchiaro G, Craig K, Marks K, Cooley K, Cox TKB, Schwartz J. Short- and long-term results of an inpatient programme to manage Complex Regional Pain Syndrome in children and adolescents. Br J Pain 2017; 11:87-96. [PMID: 28491301 DOI: 10.1177/2049463717695695] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The aim of this retrospective study was to determine whether an inpatient approach and the use of regional anaesthesia techniques can accelerate the recovery to normal functions in children with Complex Regional Pain Syndrome (CRPS). This study looked at the data of patients admitted to the rehabilitation unit with a diagnosis of CRPS from January 2010 to April 2015. Variables such as hospital stay, medications administered, regional anaesthesia procedures, changes in functional status prior to treatment and at the time of discharge, psychological evaluation and diagnosis were evaluated. A total of 31 patients (21 females and 10 males) were admitted with a diagnosis of CRPS 1 and 2. In all, 97% of the patients received a peripheral or central nerve catheter for an average of 4 days with pain scores of Verbal Numeric Scale (VNS) score = 1.0 ± 0.7 and an average length of hospital stay of 8.2 ± 2.6 days. The modified Functional Independence Measure for Children (WeeFIM) scores and Canadian Association of Occupational Therapists tests significantly improved at the time of hospital discharge, as well as their pain scores, which decreased from 8.2 ± 2 to 1.6 ± 3. In conclusion, these data suggest that the use of regional anaesthesia techniques and an intensive inpatient rehabilitation programme could accelerate the recovery of children with CRPS.
Collapse
Affiliation(s)
- Giovanni Cucchiaro
- Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Kevin Craig
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Kerri Marks
- Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Kristin Cooley
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | | | - Jennifer Schwartz
- Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| |
Collapse
|
9
|
Lascombes P, Mamie C. Complex regional pain syndrome type I in children: What is new? Orthop Traumatol Surg Res 2017; 103:S135-S142. [PMID: 27979741 DOI: 10.1016/j.otsr.2016.04.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 03/17/2016] [Accepted: 04/04/2016] [Indexed: 02/02/2023]
Abstract
Complex regional pain syndrome type I (CRPS-I), although first described by the French surgeon Ambroise Paré as far back as the 16th century, nevertheless remains shrouded in mystery. The most common symptoms are pain in an entire hand or foot, allodynia, functional impairment induced by the pain, local oedema and skin color changes and transient sweating abnormalities. Most cases occur after a minor injury (i.e., a sprain or fracture), although there may be no identifiable triggering event, particularly in children. Primarily cold CRPS-I is by far the most common variant in children. Development of the Budapest criteria has benefited the diagnosis. These criteria are clinical and no specific diagnostic investigation is available. In vitro and in vivo studies have established that several pathogenic mechanisms can be involved concomitantly. However, there is no satisfactory explanation to the full clinical spectrum. Blood tests and imaging studies are useful for ruling out other diagnoses then monitoring the course of the condition, which may involve the development of demineralisation or osteopenia. High-resolution peripheral quantitative computed tomography may be helpful, as it provides quantitative assessments of the cortical and trabecular bone. CRPS-I has several specific characteristics in children compared to adults and whether the condition is the same entity in these two age groups is a legitimate question. The optimal management involves an early diagnosis followed by a multidisciplinary management programme of functional rehabilitation therapy and cognitive behavioral therapy. Analgesics are useful only during the phase of acute pain and to facilitate physical therapy. Studies in adults showed that bisphosphonates were effective within the first 12 months after symptom onset and calcitonin in longer-lasting cases. No high-quality clinical research studies into the aetiopathogenesis and treatment of CRPS-I in children and adolescents are available to date.
Collapse
Affiliation(s)
- P Lascombes
- Division d'orthopédie pédiatrique, département de l'enfant et de l'adolescent, hôpitaux universitaires de Genève, rue Willy-Donzé 6, 1211 Genève, Switzerland.
| | - C Mamie
- Chantal Mamie MD, unité d'anesthésie pédiatrique, département d'anesthésiologie, pharmacologie et soins intensifs, hôpitaux universitaires de Genève, 1211 Genève, Switzerland.
| |
Collapse
|
10
|
Galve Villa M, Rittig-Rasmussen B, Moeller Schear Mikkelsen L, Groendahl Poulsen A. Complex regional pain syndrome. ACTA ACUST UNITED AC 2016; 26:223-230. [PMID: 27491326 DOI: 10.1016/j.math.2016.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 06/29/2016] [Accepted: 07/08/2016] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Complex regional pain syndrome (CRPS) is a chronic pain condition that can occur after a minor trauma or surgery. It is a multifactorial condition with a complex cause and even more complex pathophysiology. There are disturbances and changes in the sympathetic, somatosensory and motor nervous system, resulting in severe pain and disability. Patients with CRPS can have their quality of life and functional ability greatly affected and they need appropriate and interdisciplinary interventions. PURPOSE This article contributes towards an up-to-date knowledge and an overall view of CRPS, which can contribute to a structured and systematic rehabilitation process for patients. IMPLICATIONS This Masterclass describes a functional restoration algorithm to assist therapists in the development of a treatment plan based on the available evidence and international guidelines. Early diagnosis and treatment is of great importance as patients (adults and children), can be severely affected in their functional capacity and quality of life.
Collapse
Affiliation(s)
- Maria Galve Villa
- Pain and Headache Clinic, Aarhus University Hospital, Noerrebrogade 44, Building 1A, 8000 Aarhus C, Denmark.
| | | | - Lene Moeller Schear Mikkelsen
- The Multidisciplinary Pain Center, Copenhagen University Hospital, Rigshospitalet, Afsnit 7612, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Anne Groendahl Poulsen
- Surgical Therapy Department, Regional Hospital Silkeborg, Falkevej 1-3, 8600 Silkeborg, Denmark
| |
Collapse
|
11
|
Weissmann R, Uziel Y. Pediatric complex regional pain syndrome: a review. Pediatr Rheumatol Online J 2016; 14:29. [PMID: 27130211 PMCID: PMC4850724 DOI: 10.1186/s12969-016-0090-8] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 04/25/2016] [Indexed: 11/15/2022] Open
Abstract
Complex regional pain syndrome (CRPS) is a chronic, intensified localized pain condition that can affect children and adolescents as well as adults, but is more common among adolescent girls. Symptoms include limb pain; allodynia; hyperalgesia; swelling and/or changes in skin color of the affected limb; dry, mottled skin; hyperhidrosis and trophic changes of the nails and hair. The exact mechanism of CRPS is unknown, although several different mechanisms have been suggested. The diagnosis is clinical, with the aid of the adult criteria for CRPS. Standard care consists of a multidisciplinary approach with the implementation of intensive physical therapy in conjunction with psychological counseling. Pharmacological treatments may aid in reducing pain in order to allow the patient to participate fully in intensive physiotherapy. The prognosis in pediatric CRPS is favorable.
Collapse
Affiliation(s)
- Rotem Weissmann
- Pediatric Rheumatology Unit, Department of Pediatrics, Meir Medical Center, 49 Tshernichovsky St., Kfar Saba, 44281 Israel ,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yosef Uziel
- Pediatric Rheumatology Unit, Department of Pediatrics, Meir Medical Center, 49 Tshernichovsky St., Kfar Saba, 44281, Israel. .,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| |
Collapse
|
12
|
Ruhe AK, Wager J, Hirschfeld G, Zernikow B. Household income determines access to specialized pediatric chronic pain treatment in Germany. BMC Health Serv Res 2016; 16:140. [PMID: 27102117 PMCID: PMC4840873 DOI: 10.1186/s12913-016-1403-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 04/18/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Families with lower socioeconomic status (SES) often face problems with gaining access to health care services. Information is scarce on the relationship between SES and health care delivery for children suffering from chronic pain. METHODS Families presenting to a specialized pain center (N = 1,001) provided information on 'household income, 'parental education' and 'occupation' to aid the evaluation of their SES. To assess whether the SES of the clinical sample is representative of the general population, it was compared to data from a community sample (N = 14,558). For the clinical sample, travel distance to the clinic was described in relation to the 75% catchment area. Multiple logistic regression was used to analyze the association between SES and the journey from outside the catchment area. RESULTS The SES was significantly higher in the clinical sample than in the community sample. Within the clinical sample, the distance traveled to the pain center increased with increasing SES. The 75% catchment area was 143 miles for families with the highest SES and 78 miles for the lowest SES. 'Household income' predicted travel distance (OR 1.32 (1.12-1.56)). Education and occupational status were not significant predictors of travel from outside the catchment area. CONCLUSIONS In Germany, specialized care for children with chronic pain is subject to disparities in access. Future activities should focus on identifying barriers to access and seeking to prevent inequalities in specialized pediatric health care delivery. Increasing the number of specialized treatment facilities could improve access to specialized pediatric pain treatment, regardless of socioeconomic determinants.
Collapse
Affiliation(s)
- Ann-Kristin Ruhe
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, and Department of Children's Pain Therapy and Paediatric Palliative Care, Witten/Herdecke University, Faculty of Health - School of Medicine, Dr.-Friedrich-Steiner-Str .5, 45711, Datteln, Germany.
| | - Julia Wager
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, and Department of Children's Pain Therapy and Paediatric Palliative Care, Witten/Herdecke University, Faculty of Health - School of Medicine, Dr.-Friedrich-Steiner-Str .5, 45711, Datteln, Germany
| | - Gerrit Hirschfeld
- Faculty of Economics and Social Sciences, University of Applied Sciences Osnabrück , Caprivistr. 30A, 49076, Osnabrück, Germany
| | - Boris Zernikow
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, and Department of Children's Pain Therapy and Paediatric Palliative Care, Witten/Herdecke University, Faculty of Health - School of Medicine, Dr.-Friedrich-Steiner-Str .5, 45711, Datteln, Germany
| |
Collapse
|
13
|
Rodriguez- Lopez MJ, Fernandez-Baena M, Barroso A, Yáñez-Santos JA. Complex Regional Pain Syndrome in Children: a Multidisciplinary Approach and Invasive Techniques for the Management of Nonresponders. Pain Pract 2015; 15:E81-9. [DOI: 10.1111/papr.12317] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 04/07/2015] [Indexed: 11/27/2022]
Affiliation(s)
| | | | - Alex Barroso
- Pain Treatment Unit of Hospital Regional Universitario de Malaga; Malaga Spain
| | | |
Collapse
|
14
|
|
15
|
Drake R, Anderson BJ, van den Anker JN, Zernikow B. Managing persisting pain in children with medical illnesses: another frontier unexplored. Paediatr Anaesth 2013; 23:381-4. [PMID: 23577820 DOI: 10.1111/pan.12141] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Ross Drake
- Starship Children's Hospital; Auckland; New Zealand
| | | | | | | |
Collapse
|