Pain Symptoms Persistent in Childhood Complex Regional Pain Syndrome

Patients who were diagnosed with complex regional pain syndrome (CRPS) during childhood or early adulthood experienced long-lasting pain symptoms, according to a study published in Pain Reports.

Patients treated for CRPS at the Stanford Children’s Heath and the Packard Children’s Hospital at Stanford between 1994 and 2018 were sent surveys through the mail. The questionnaires included the Short Form-8 (SF-8) Health Survey and assessed the current state of their CRPS symptoms.

This analysis included 53 completed surveys, which was a response rate of 50%. Patients were aged 13.5±2.2 years at diagnosis, aged 19.1±2.0 years at time of the survey, 77% respondents were women, and 40 respondents were White.

All participants reported receiving a multidisciplinary treatment model, which was standard care for pediatric CRPS. The mean follow-up time was 6.0 years (range, 19 months-13.5 years) and most were treated as outpatients (60%).

Patients received peripheral and/or sympathetic nerve blocks (76%), psychotherapy (83%), and physical therapy (100%). Gabapentin (77%) and tricyclic or serotonin-norepinephrine reuptake inhibitors (81%) were prescribed to the patients.

At the time of the survey, 68% were experiencing pain and 38% had a spread of their CRPS symptoms. Reported pain was correlated with the age of diagnosis, in which with every 1-year increment, the odds of pain increased by 1.61 (P =.005).

Half of the participants indicated they were currently taking at least 1 opioid medication. Patients who were prescribed opioids reported more pain in the CRPS limb and overall severe body pain.

The reported physical component score (PCS) of the SF-8 was 44.4 (95% CI, 3.3) and 43.4 (95% CI, 3.4) for the mental component (MCS), both of which were lower than the average score of adults in the United States. These scores did not differ significantly among patients with (PCS: 39.3±10.8; MCS: 40.9±11.7) or without (PCS: 55.7±4.0; MCS: 48.83±12.6) pain.

This study may have been limited by the response rate among the older individuals. The investigators attempted to contact former patients using their physical address, email address, or telephone. Patients who had been treated at the center during the 1990’s were more difficult to contact, as their contact information was not up-to-date. It remains unclear from these data what levels of pain were experienced by patients decades after their CRPS diagnoses.

Despite the prevailing belief that short-term prognosis of CRPS among children is favorable in nearly all cases, these data indicated that only a minority of individuals who were treated for childhood CRPS are symptom- or disease-free during early adulthood.

Long-term analyses are needed among this patient population to assess lasting pain symptoms.

Reference

Wong B J, Yoon I A, and Krane E J. Outcome in young adults who were diagnosed with complex regional pain syndrome in childhood and adolescence. Pain Rep. 2020;5(6):e860.