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Complex Regional Pain Syndrome Still Slow to Be Diagnosed in Children

CRPS, or complex regional pain syndrome, is a pain disorder that causes constant, intense pain in the arms and legs, along with problems with the blood vessels and sweat glands. It was identified as early as the American Civil War, but was though to affect mostly adults and rarely children. Doctor's don't yet know what causes CRPS or how best to treat it. They do realize that children do have the disorder more than previously thought.

This study reviewed the medical records of 20 children diagnosed with CRPS over a four-year period at one specific hospital. The researchers noted past history, family history, the time it took from onset of symptoms to diagnosis and the time it took for the symptoms to go away. They also noted the type of treatment the children received, the length of any hospital stay, and any replapes.

All the children received the same treatment: intensive physiotherapy, hydrotherapy (exercise in water), massage, medications for pain, and counseling. Often the analgesics, or pain medications were needed before the children could take part in their physiotherapy session. Thirteen children were treated with other medications such as amitriptyline and three received gabapentin because these medications have been found to work for some people with chronic pain. The counseling, or psychotherapy, was given to help the children learn how to cope with the pain and other stressful situations. Two families refused counseling for their children.

Those children who were admitted to the hospital were not seeing any improvement with their therapy or their pain had increased to the point that it was felt that the pain could be better controlled better in the hospital environment. All the children were followed until their symptoms had gone, only two children were lost to follow-up.

Of the 20 children, 18 were girls. All the children ranged in age from 8 to 16 years. The average onset of the symptoms in girls was around age 12 years and in boys, almost 9 years. In 17 children, the pain was in the legs, 15 complained of foot pain, one of ankle pain and one of knee pain. Half of these children reported the pain to be on the left side. The pain was in the arms for three children: two complained of it in the right wrist and hand, and one in the entire left arm.

Sixteen of the children said that they had hurt themselves before the symptoms began, but the injuries were minor from falls or sprains. Only one injury was a fracture.

All the children began complaining of pain that seemed out of proportion to the injury. Most also had swelling, one side was warmer to touch than the other, and the skin color changed as well.

The researchers found that it took an average of about 13 and a half weeks from the time that the children experienced their first symptoms to the time they were finally diagnosed. The children would have seen anywhere from one to six specialists in orthopedics, pediatrics, rheumatology, neurology, emergency, and family physicians.

Four of the children had relapses after being symptom-free for at least three months.

The study showed that there were differences between the adults who have CRPS and children with the same disease. In adults, the legs are not as affected as with the children, and in adults, there were more men than there were boys in the children.

The authors of the study concluded there was a concern about the length of time between when the patients presented with the symptoms and the final diagnosis. It has improved from a decade ago when the length of time was as long as a year, to three months at the time of this study. That being said, it still took six months for three of the children in the study to be diagnosed. This is particularly important because the undiagnosed children are suffering from the pain, and findings show that children who are treated within three months of developing the symptoms respond better to treatment.

References: Adrian K Low, MBBS, et al. Pediatric Complex Regional Pain Syndrome. In Journal of Pediatric Orthopaedics. July/August 2007. Vol. 27. No. 5. Pp. 567-572.

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