Characteristics of Pediatric Complex Regional Pain Syndrome

A physician examining a child
A physician examining a child

Complex regional pain syndrome (CRPS) in children was found to occur more frequently in the lower extremities and in girls and was associated with improvement after treatment, according to a study published in the Clinical Journal of Pain.

The study included children with CRPS who visited a pediatric chronic pain clinic in Canada over a 5-year period (n=59; mean age, 12.7±2.5 years; 74.6% girls; 72.9% with lower extremity CRPS). The researchers conducted a retrospective chart review in which they collected demographic features including participants’ age at initial visit, symptom duration at time of initial visit, sex, and medical history, as well as data on the type and location of CRPS and on participant-reported symptoms and clinician-observed signs of CRPS. Pain intensity was assessed using the 11-point Numeric Rating Scale (NRS-11).

The most common nonpharmacologic treatments were physiotherapy (n=52; 88.1%) and psychological therapy (n=30; 50.8%). A total of 79% of participants were prescribed a medication: gabapentin (n=30; 50.8%), amitriptyline (n=17; 28.8%), acetaminophen (n=17; 28.8%), nonsteroidal anti-inflammatory drugs (n=18; 30.5%), tramadol (n=7; 11.9%), and other opioids (n=1; 1.7%).

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During the study period, 87% (n=48) of participants experienced complete resolution or significant improvement of CRPS. Of these, 15% experienced relapse.

In this cohort, 25% (n=15) had a CRPS-related movement disorder. The clinical presentation of CRPS was comparable in participants with vs without movement disorders. Participants with vs without CRPS-related movement disorders had a trend toward longer symptom duration at the time of the initial visit.

Study limitations include the small sample size and retrospective chart review design. In addition, adult-based diagnostic criteria were used to define the study cohort due to a lack of valid diagnostic criteria for pediatric CRPS.

“Future research in pediatric CRPS should endeavor to validate diagnostic criteria to aid in making clinical diagnoses and to define populations for future studies,” noted the researchers.


Mesaroli G, Ruskin D, Campbell F, et al. Clinical features of pediatric complex regional pain syndrome: a 5-year retrospective chart review [published online September 4, 2019]. Clin J Pain. doi:10.1097/AJP.0000000000000759