Rodriguez Manuel J, Fernandez-Baena Mariano, Barroso Alex, Yanez Jose A
Pain Treatment Unit. Hospital Regional Universitario "Carlos Haya" de Malaga, Spain.
Pain Physician. 2015 Nov;18(6):621-30.
Complex regional pain syndrome (CRPS) is a 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. There is a variety of invasive methods to the treatment of CRPS, but scarce pediatric-focused trials have been published to date.
To examine and analyze the data currently existing for the invasive management of CRPS in children. It further suggests a management algorithm based in the evidence reviewed and our team experience.
A comprehensive review of invasive management for pediatric CRPS.
Academic hospital in Spain.
A comprehensive review of all the evidence published to date was conducted. Four databases (PubMed, Medline, Web of Science, Embase, and Cochrane databases) were searched for articles published from 1980 to 2014. The eligibility criteria were any paper published in English or Spanish where a non-conventional approach was used to manage pediatric CRPS. Two independent reviewers extracted the data.
Many case series have reported the use of interventional management with positive results; however, there is not a single randomized control trial to date comparing the conservative and the invasive management in children. The largest series of pediatric cases showed that between 29% to 35% of children with CRPS needed interventional measures to manage this condition successfully. Sympathetic blocks and spinal drug infusion emerge as the most reported techniques; the spinal infusion of drugs together with the spinal cord stimulation being the most successfully employed. Based upon the available evidence with regard to effect and complications, we recommend an algorithm for the management of pediatric CRPS.
The limitations of this study include the paucity of literature, lack of randomized trials, and lack of quality evidence.
Invasive techniques have been used to treat CRPS over the last few decades; however, the evidence for their use is still very weak. Invasive management should be contemplated only when high-standard conservative management has failed to work.
复杂性区域疼痛综合征（CRPS）是一种多因素疾病，发病机制复杂，其特征为自发痛或刺激诱发痛，疼痛程度与诱发事件不成比例。它通常还伴有多种自主神经和运动功能障碍，且组合形式高度可变。直到最近，这种疾病在儿童中的报道都较少。因此，儿童CRPS的治疗比成人面临更大的挑战，部分原因是缺乏关于现有多种治疗方法疗效的临床数据，部分原因是CRPS的成功治疗需要多学科方法。治疗CRPS有多种侵入性方法，但迄今为止，针对儿童的相关试验很少。
检查和分析目前关于儿童CRPS侵入性治疗的现有数据。并根据所审查的证据和我们团队的经验，提出一种治疗方案。
对儿童CRPS侵入性治疗进行全面综述。
西班牙的一家学术医院。
对迄今为止发表的所有证据进行全面综述。检索了四个数据库（PubMed、Medline、科学网、Embase和Cochrane数据库），查找1980年至2014年发表的文章。纳入标准为任何以英文或西班牙文发表的、采用非传统方法治疗儿童CRPS的论文。两名独立评审员提取数据。
许多病例系列报告了介入治疗的使用且结果积极；然而，迄今为止尚无一项比较儿童保守治疗和侵入性治疗的随机对照试验。最大规模的儿童病例系列显示，29%至35%的CRPS儿童需要采取介入措施才能成功治疗该病。交感神经阻滞和脊髓药物输注是报道最多的技术；脊髓药物输注与脊髓刺激联合使用最为成功。基于关于疗效和并发症的现有证据，我们推荐一种儿童CRPS的治疗方案。
本研究的局限性包括文献数量少、缺乏随机试验以及缺乏高质量证据。
在过去几十年中，侵入性技术已被用于治疗CRPS；然而，其使用证据仍然非常薄弱。仅当高标准的保守治疗无效时，才应考虑侵入性治疗。
