Mosquera-Moscoso Johanna, Eldrige Jason, Encalada Sebastian, Mendonca Laura Furtado Pessoa de, Hallo-Carrasco Alejandro, Shan Ali, Rabatin Amy, Mina Maged, Prokop Larry, Hunt Christine
Department of Family Medicine, Mayo Clinic, Jacksonville, FL, USA.
Department of Pain Medicine, Mayo Clinic, Jacksonville, FL, USA.
Interv Pain Med. 2024 Dec 2;3(4):100532. doi: 10.1016/j.inpm.2024.100532. eCollection 2024 Dec.
Complex Regional Pain Syndrome (CRPS) is a condition that causes persistent and debilitating pain. It is often associated with physical injury but can also occur without identifiable trauma or ongoing injury. There are no published guidelines for CRPS treatment in the pediatric population, but interdisciplinary care, medication, and physical therapy are common approaches. Sometimes, interventional procedures such as regional anesthesia may be required to manage symptoms.
The objective of this literature review is to explore the different interventional pain management approaches that are currently being used and have shown effectiveness in the management of CRPS in the pediatric population.
We conducted a comprehensive search strategy with an experienced librarian and input from the study's principal investigator from January 1st, 2000 to April 2nd, 2024. The search was conducted in multiple databases using controlled vocabulary and keywords to identify studies relevant to invasive treatments for pediatric CRPS.
Of 825 studies screened, 27 met inclusion criteria, predominantly case reports (70%). The analysis included 183 patients aged 7-18 years, with female predominance (81.4%). Lower extremities were most commonly affected (70.49%), and most cases (83.06%) were triggered by identifiable trauma. IASP and Budapest criteria, though not validated for pediatric populations, were inconsistently utilized across studies for CRPS diagnosis. Interventional procedures were typically implemented after failed conservative management (92.89%), which included multiple medications (e.g., pregabalin, amitriptyline, NSAIDs) combined with physical and psychological therapy. Multiple interventional procedures were often required to achieve pain relief or functional improvement. Follow-up periods were not reported in most studies and, when reported, were short, limiting the assessment of long-term intervention efficacy.
This review summarizes the different interventional pain management methods utilized to treat pediatric CRPS. While techniques such as continuous epidural anesthesia, lumbar sympathetic blocks, peripheral procedures, and spinal cord stimulation have been safely and successfully used as part of a multimodal treatment strategy, the lack of high-quality evidence and specific protocols for CRPS diagnosis and management in pediatric patients calls for further research.
复杂性区域疼痛综合征（CRPS）是一种导致持续性和使人衰弱疼痛的病症。它常与身体损伤相关，但也可能在没有可识别的创伤或持续损伤的情况下发生。目前尚无针对儿科人群CRPS治疗的已发表指南，但多学科护理、药物治疗和物理治疗是常见的治疗方法。有时，可能需要诸如区域麻醉等介入性程序来控制症状。
本文献综述的目的是探讨目前正在使用且已证明对儿科人群CRPS管理有效的不同介入性疼痛管理方法。
我们与一位经验丰富的图书馆员进行了全面的检索策略，并在2000年1月1日至2024年4月2日期间纳入了该研究的主要研究者的意见。检索在多个数据库中进行，使用控制词汇和关键词来识别与儿科CRPS侵入性治疗相关的研究。
在筛选的825项研究中，27项符合纳入标准，主要是病例报告（70%）。分析纳入了183名7至18岁的患者，女性占优势（81.4%）。下肢最常受累（70.49%），大多数病例（83.06%）由可识别的创伤引发。国际疼痛研究协会（IASP）和布达佩斯标准虽未在儿科人群中得到验证，但在各项研究中对CRPS诊断的使用并不一致。介入性程序通常在保守治疗失败后实施（92.89%），保守治疗包括多种药物（如普瑞巴林、阿米替林、非甾体抗炎药）联合物理和心理治疗。通常需要多种介入性程序才能实现疼痛缓解或功能改善。大多数研究未报告随访期，即便报告了，随访期也较短，这限制了对长期干预疗效的评估。
本综述总结了用于治疗儿科CRPS的不同介入性疼痛管理方法。虽然诸如连续硬膜外麻醉、腰交感神经阻滞、外周手术和脊髓刺激等技术已作为多模式治疗策略的一部分被安全且成功地使用，但缺乏关于儿科患者CRPS诊断和管理的高质量证据及具体方案，这需要进一步研究。
