Children with complex regional pain syndrome or CRPS often suffer intense pain and swelling of the affected arm and hand or leg and foot. They also experience skin changes (color, texture, hair growth, temperature). The net result is a loss of motion and function along with reduced quality of life.
Children develop CRPS most often after an injury as minor as having blood drawn, or a sprained ankle. Other times, it may be the result of a more significant injury such as surgery, a fracture, immobilization with casting or splinting.
Risk factors for developing CRPS include immobilization of the affected limb with a cast, splint or sling; genetics; and psychological factors. The problem is not understood very well. Doctors don’t really know what causes it or why it happens. That makes CRPS a difficult condition to treat effectively.
But the good news is that several large pediatric centers have developed a method of treatment that seems to be very effective. At one U.S. hospital, 100 per cent of the children were “cured” — all symptoms resolved. Physicians at a similar Canadian hospital agreed that the steps used worked for them, too.
Step one is a review of all the ways the child has already been treated so far. Most often, medications have been prescribed and the child has worked with a physical therapist. Step two: if previous medications (usually pain relievers and/or antiinflammatories) have not worked, a second line of drugs to try are muscle relaxants and anticonvulsants.
Step three: the child goes back to physical therapy for a more aggressive approach. Failure to achieve pain relief and return of function with these measures results in step four: a referral for a sympathetic (nerve) block.
If the nerve block works, then great! But if it only provides temporary relief from pain, at least it’s clear that the team is on the right track. Inpatient hospitalization is recommended. That’s when the multidisciplinary team gets to work.
The surgeon provides a continuous block to the nerve while the physical therapist works with the child in a total program of sensory modulation, postural alignment, desensitization, motion and movement training and strengthening (as appropriate). During this five-day intense in-patient treatment, a psychologist also offers psychological therapy and behavioral training.
This type of multidisciplinary treatment approach to complex regional pain syndrome (CRPS) is worth a try. Studies show that the earlier nerve blocks are used, the better the results. Waiting months to years results in a slower recovery time.