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Sherry DD, Mondal A, McGill M, Gmuca S. Pediatric Complex Regional Pain Syndrome With and Without a History of Prior Physical Trauma at Onset. Clin J Pain 2023; 39:437-441. [PMID: 37335219 PMCID: PMC10399929 DOI: 10.1097/ajp.0000000000001140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 05/16/2023] [Accepted: 06/09/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVE To determine whether differences exist between children with complex regional pain syndrome (CRPS) who identify an inciting physical traumatic event (group T) versus those without such history (group NT). METHODS We performed a single-center, retrospective study of children diagnosed with CRPS, 18 years old or younger, presenting between April 2008 and March 2021 and enrolled in a patient registry. Abstracted data included clinical characteristics, pain symptoms, Functional Disability Inventory, psychological history, and Pain Catastrophizing scale for children. Charts were reviewed for outcome data. RESULTS We identified 301 children with CRPS, 95 (64%) reported prior physical trauma. There was no difference between the groups regarding age, sex, duration, pain level, function, psychological symptoms, and scores on the Pain Catastrophizing Scale for Children. However, those in group T were more likely to have had a cast (43% vs 23%, P < 0.001). Those in group T were less likely to experience complete resolution of symptoms (64% vs 76%, P = 0.036). There were no other outcome differences between the groups. DISCUSSION We found minimal differences in children with CRPS who report a prior history of physical trauma to those who do not. Physical trauma may not play as significant a role as immobility, such as casting. The groups mostly had similar psychological backgrounds and outcomes.
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Affiliation(s)
- David D. Sherry
- Division of Rheumatology, Department of Pediatrics, Children’s Hospital of Philadelphia
- University of Pennsylvania Perelman School of Medicine and Children’s Hospital of Philadelphia
| | - Antara Mondal
- Department of Biomedical and Health Informatics, Data Science and Biostatistics Unit, the Children’s Hospital of Philadelphia
| | - Mackenzie McGill
- Division of Rheumatology, Department of Pediatrics, Children’s Hospital of Philadelphia
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia
- Policy Lab, Children’s Hospital of Philadelphia, Roberts Center for Pediatric Research, Philadelphia, PA
| | - Sabrina Gmuca
- Division of Rheumatology, Department of Pediatrics, Children’s Hospital of Philadelphia
- University of Pennsylvania Perelman School of Medicine and Children’s Hospital of Philadelphia
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia
- Policy Lab, Children’s Hospital of Philadelphia, Roberts Center for Pediatric Research, Philadelphia, PA
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Baerg K, Tupper SM, Chu LM, Cooke N, Dick BD, Doré-Bergeron MJ, Findlay S, Ingelmo PM, Lamontagne C, Mesaroli G, Oberlander TF, Poolacherla R, Spencer AO, Stinson J, Finley GA. Canadian surveillance study of complex regional pain syndrome in children. Pain 2022; 163:1060-1069. [PMID: 34799536 PMCID: PMC9100430 DOI: 10.1097/j.pain.0000000000002482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 08/28/2021] [Accepted: 09/07/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT This study describes the minimum incidence of pediatric complex regional pain syndrome (CRPS), clinical features, and treatments recommended by pediatricians and pain clinics in Canada. Participants in the Canadian Paediatric Surveillance Program reported new cases of CRPS aged 2 to 18 years monthly and completed a detailed case reporting questionnaire from September 2017 to August 2019. Descriptive analysis was completed, and the annual incidence of CRPS by sex and age groupings was estimated. A total of 198 cases were reported to the Canadian Paediatric Surveillance Program, and 168 (84.8%) met the case definition. The minimum Canadian incidence of CRPS is estimated at 1.14/100,000 (95% confidence interval 0.93-1.35/100,000) children per year. Incidence was highest among girls 12 years and older (3.10, 95% confidence interval 2.76-3.44/100,000). The mean age of CRPS diagnosis was 12.2 years (SD = 2.4), with the mean time from symptom onset to diagnosis of 5.6 months (SD = 9.9) and no known inciting event for 19.6% of cases. Most cases had lower limb involvement (79.8%). Nonsteroidal anti-inflammatory drugs (82.7%) and acetaminophen (66.0%) were prescribed more commonly than antiepileptic drugs (52.3%) and antidepressants (32.0%). Referrals most commonly included physical therapy (83.3%) and multidisciplinary pain clinics (72.6%); a small number of patients withdrew from treatment because of pain exacerbation (5.3%). Pain education was recommended for only 65.6% of cases. Treatment variability highlights the need for empiric data to support treatment of pediatric CRPS and development of treatment consensus guidelines.
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Affiliation(s)
- Krista Baerg
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Canada
- Department of Pediatrics, Saskatchewan Health Authority, Saskatoon, Canada
| | - Susan M. Tupper
- Department of Clinical Excellence, Quality, Safety & Strategy, Saskatchewan Health Authority, Saskatoon, Canada
| | - Luan Manh Chu
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Canada
| | | | - Bruce D. Dick
- Departments of Anesthesiology and Pain Medicine, Psychiatry & Pediatrics, University of Alberta, Edmonton, Canada
- Faculties of Medicine and Dentistry & Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | | | - Sheri Findlay
- Department of Pediatrics, McMaster University, Hamilton, Canada
| | - Pablo M. Ingelmo
- Chronic Pain Service, Montreal Children's Hospital, McGill University Health Center, Montréal, Canada
| | - Christine Lamontagne
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Canada
| | - Giulia Mesaroli
- Department of Rehabilitation, The Hospital for Sick Children, Toronto, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| | | | - Raju Poolacherla
- Department of Anesthesia and Perioperative Medicine and Department of Pediatrics, Children's Hospital London Health Sciences Centre, London, Canada
| | - Adam Oscar Spencer
- Department of Pediatric Anesthesia, University of Calgary Cumming School of Medicine, Calgary, Canada
| | - Jennifer Stinson
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - G. Allen Finley
- Departments of Anesthesia & Psychology, Dalhousie University, Halifax, Canada
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Javed S, Abdi S. Use of anticonvulsants and antidepressants for treatment of complex regional pain syndrome: a literature review. Pain Manag 2020; 11:189-199. [PMID: 33183126 DOI: 10.2217/pmt-2020-0060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Complex regional pain syndrome (CRPS) is characterized by pain accompanied by symptoms including skin changes, sensory, motor, trophic changes and autonomic dysfunction. Anticonvulsants and antidepressants are commonly prescribed for neuropathic pain conditions; however, evidence is sparse whether these drugs are effective in reducing CRPS-related pain. As such, Pubmed was searched for studies published from January 1990 through March 2020; 13 studies were included in this review. Overall, evidence is considered insufficient for use of gabapentinoids for CRPS-related pain. However, three randomized controlled trials (RCTs) did find gabapentin to result in significant improvement in pain whereas one RCT reported use of amitriptyline to be equally as effective as gabapentin. Multiple case reports discussing the efficacy of pregabalin in pediatric CRPS patients, with relatively short duration of disease and underlying psychiatric illness, have been reported, but these findings need to be validated with RCTs.
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Affiliation(s)
- Saba Javed
- University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Salahadin Abdi
- University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Egunsola O, Wylie CE, Chitty KM, Buckley NA. Systematic Review of the Efficacy and Safety of Gabapentin and Pregabalin for Pain in Children and Adolescents. Anesth Analg 2019; 128:811-819. [DOI: 10.1213/ane.0000000000003936] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abu-Arafeh H, Abu-Arafeh I. Complex regional pain syndrome in children: a systematic review of clinical features and movement disorders. Pain Manag 2017; 7:133-140. [DOI: 10.2217/pmt-2016-0036] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Aim: To ascertain clinical features of complex regional pain syndrome (CRPS) in children with a focus on movement disorders. Methods: all publications with original data on children with CRPS were assessed. Data were tabulated and descriptive statistics were applied. Results: One population-based study and nine clinic-based studies provided data on demographic and clinical characteristics of childhood CRPS. Mean age of onset was 12.5 years and 85% of patients were females (risk ratio: 1.70; 95% CI: 1.54−1.88). History of trauma in 71% and the lower limbs were affected in 75% of patients. A secondary site involvement was present in 15%. Movement disorders and dystonia were reported in 30% of children. Conclusion: Majority of cases of CRPS in children are females with mean age of 12.5 years. Movement disorders (mainly dystonia) affect at least one in three children with CRPS.
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Affiliation(s)
- Hashem Abu-Arafeh
- University of Edinburgh, Edinburgh, UK
- Forth Valley Royal Hospital, Stirlingshire, Larbert, FK5 4WR, UK
| | - Ishaq Abu-Arafeh
- Forth Valley Royal Hospital, Stirlingshire, Larbert, FK5 4WR, UK
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Abu-Arafeh H, Abu-Arafeh I. Complex regional pain syndrome in children: incidence and clinical characteristics. Arch Dis Child 2016; 101:719-23. [PMID: 27005945 DOI: 10.1136/archdischild-2015-310233] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 02/27/2016] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To study the clinical and epidemiological characteristics of complex regional pain syndrome (CRPS) in children. PATIENTS AND METHODS All children and adolescents under 16 years of age with a new diagnosis of CRPS who were reported to the Scottish Paediatric Surveillance Unit were included. Patients' recruitment ran between 1 November 2011 and 31 October 2015. Information was collected on patients' demography, clinical features, investigations, management and impact of disease on child and family. The diagnosis of CRPS was made on fulfilling the clinical criteria of the International Association for the Study of Pain. RESULTS 26 cases of CRPS were reported over 4 years, giving a minimum estimated incidence of 1.16/100 000 (95% CI 0.87 to 1.44/100 000) children 5-15 years of age. Nineteen patients were female (73%) and mean age at diagnosis was 11.9 (range 5.5-15.4 years). The median interval between onset of symptoms and diagnosis was 2 months (range 1-12). The majority of children have single site involvement, with legs been more often affected than arms and the right side is more often affected than the left. There was a clear trauma at onset of the illness in 19 children and possible nerve injury in one. All investigations were normal and several treatment modalities were used with variable success. The disease had significant impacts on the patients' education and family lives. CONCLUSIONS The estimated incidence of CRPS is 1.2/100 000 children 5-15 years old. The diagnosis of CRPS is often delayed. CRPS has a significant impact on children and their families.
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Affiliation(s)
- Hashem Abu-Arafeh
- University of Edinburgh, Edinburgh, UK Department of Paediatrics, Forth Valley Royal Hospital, Larbert, Stirlingshire, UK
| | - Ishaq Abu-Arafeh
- Department of Paediatrics, Forth Valley Royal Hospital, Larbert, Stirlingshire, UK
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