Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Section of Pediatric Neurosurgery, Department of Neurological Surgery, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A.
Pain Pract. 2020 Jul;20(6):647-655. doi: 10.1111/papr.12882. Epub 2020 Apr 13.
In the pediatric population, complex regional pain syndrome (CRPS) is a debilitating chronic pain syndrome that is classically treated with escalating polypharmacy and physical therapy. Failure of therapy is often encountered in both adult and pediatric patients with CRPS, after which invasive neuromodulatory therapy might be considered. Intrathecal drug delivery systems and spinal cord stimulation (SCS) have been reported in the literature as forms of neuromodulation effective in adult CRPS; however, SCS remains inadequately researched and underreported in the pediatric CRPS population. Owing to the differences in patient population characteristics and the specific vulnerability of adolescents to drugs that might be used to manage refractory cases, including but not limited to opioids, we believe that early effective pain management without the use of chronic pain medications is of paramount importance.
Recent evidence suggests that neuromodulation can be useful toward improving function and managing pain, while also reducing medication use in chronic pain patients. A representative case a review of the literature is performed.
We report the effective treatment of CRPS in a pediatric patient following implantation of an SCS device typifying the improved pain scores, decreased medication use, and substantially improved functional abilities in pediatric patients following SCS.
The manuscript objective is to stimulate a discussion for SCS use earlier in the therapeutic management of CRPS in children.
在儿科人群中，复杂性区域疼痛综合征（CRPS）是一种使人衰弱的慢性疼痛综合征，经典的治疗方法是逐步增加药物治疗和物理治疗。在成人和儿科 CRPS 患者中，经常会遇到治疗失败的情况，此时可能会考虑采用侵入性神经调节治疗。在文献中，鞘内药物输送系统和脊髓刺激（SCS）已被报道为对成人 CRPS 有效的神经调节形式；然而，SCS 在儿科 CRPS 人群中的研究和报道仍然不足。由于患者人群特征的差异，以及青少年对可能用于治疗难治性病例的药物（包括但不限于阿片类药物）的特殊脆弱性，我们认为，在不使用慢性疼痛药物的情况下，早期有效控制疼痛至关重要。
最近的证据表明，神经调节对于改善功能和管理疼痛，同时减少慢性疼痛患者的药物使用是有用的。我们进行了一项文献综述和案例回顾。
我们报告了一例 SCS 设备植入后治疗 CRPS 的有效病例，该病例的疼痛评分得到改善，药物使用减少，并且在 SCS 治疗后儿童患者的功能能力得到了显著提高。
本文的目的是探讨在儿童 CRPS 的治疗管理中更早地使用 SCS 的问题。
