Children and Adolescents with Complex Regional Pain Syndrome: More Psychologically Distressed than Other Children in Pain?

BACKGROUND: Historically, in both adult and pediatric populations, a lack of knowledge regarding complex regional pain syndrome (CRPS) and absence of clear diagnostic criteria have contributed to the view that this is a primarily psychiatric condition.OBJECTIVE: To test the hypothesis that children with CRPS are more functionally disabled, have more pain and are more psychologically distressed than children with other pain conditions.METHODS: A total of 101 children evaluated in a tertiary care pediatric pain clinic who met the International Association for the Study of Pain consensus diagnostic criteria for CRPS participated in the present retrospective study. Comparison groups included 103 children with abdominal pain, 291 with headache and 119 with back pain. Children and parents completed self-report questionnaires assessing disability, somatization, pain coping, depression, anxiety and school attendance.RESULTS: Children with CRPS reported higher pain intensity and more recent onset of pain at the initial tertiary pain clinic evaluation compared with children with other chronic pain conditions. They reported greater functional disability and more somatic symptoms than children with headaches or back pain. Scores on measures of depression and anxiety were within normal limits and similar to those of children in other pain diagnostic groups.CONCLUSIONS: As a group, clinic-referred children with CRPS may be more functionally impaired and experience more somatic symptoms compared with children with other pain conditions. However, overall psychological functioning as assessed by self-report appears to be similar to that of children with other chronic pain diagnoses. Comprehensive assessment using a biopsychosocial framework is essential to understanding and appropriately treating children with symptoms of CRPS.

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Characteristics of Complex Regional Pain Syndrome in Patients Referred to a Tertiary Pain Clinic by Community Physicians, Assessed by the Budapest Clinical Diagnostic Criteria

Pain Medicine ◽

10.1111/pme.12584 ◽

2014 ◽

Vol 15 (11) ◽

pp. 1965-1974 ◽

Cited By ~ 12

Author(s):

Angela Mailis-Gagnon ◽

Shehnaz Fatima Lakha ◽

Matti D. Allen ◽

Amol Deshpande ◽

Robert Norman Harden

Keyword(s):

Complex Regional Pain Syndrome ◽

Diagnostic Criteria ◽

Pain Syndrome ◽

Pain Clinic ◽

Clinical Diagnostic ◽

Clinical Diagnostic Criteria

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Proposed New Diagnostic Criteria for Complex Regional Pain Syndrome

Pain Medicine ◽

10.1111/j.1526-4637.2006.00169.x ◽

2007 ◽

Vol 8 (4) ◽

pp. 326-331 ◽

Cited By ~ 538

Author(s):

R. Norman Harden ◽

Stephen Bruehl ◽

Michael Stanton-Hicks ◽

Peter R. Wilson

Keyword(s):

Complex Regional Pain Syndrome ◽

Diagnostic Criteria ◽

Pain Syndrome

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Ketamine Infusions for Complex Regional Pain Syndrome

10.2310/pm.15081 ◽

2016 ◽

Author(s):

Roy K. Esaki

Keyword(s):

Chronic Pain ◽

Complex Regional Pain Syndrome ◽

Hepatic Dysfunction ◽

Case Reports ◽

Pain Syndrome ◽

Nmda Receptor Antagonist ◽

Treatment Resistant ◽

Urinary Tract Symptoms ◽

Chronic Pain Conditions ◽

Lower Urinary

Ketamine is an N-methyl-d-aspartate (NMDA) receptor antagonist that has been increasingly used in the management of treatment-resistant chronic pain conditions, particularly representing neuropathic involvement or central sensitization. Complex regional pain syndrome (CRPS) is a prototypical condition often treated with ketamine infusions. Although the analgesic benefits of ketamine as an opioid-sparing adjunct in the preoperative period have been well studied, the use of ketamine to mitigate chronic pain conditions remains largely anecdotal, composed largely of case reports and uncontrolled small studies. The limited evidence and published reports support the use of ketamine infusions as one aspect of a comprehensive, multimodal approach for CRPS. Although ketamine infusions are relatively safe when titrated appropriately, with minimal respiratory depression, side effects include sympathetic activation, unpleasant psychomimetic effects, lower urinary tract symptoms, and hepatic dysfunction.

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Radiofrequency therapy in back pain and complex regional pain syndrome

Rheumatology Reports ◽

10.4081/rr.2011.e12 ◽

2011 ◽

Vol 3 (1) ◽

pp. 12

Author(s):

Norina Bergamin ◽

Armin Aeschbach ◽

Beat A. Michel ◽

Haiko Sprott

Keyword(s):

Back Pain ◽

Complex Regional Pain Syndrome ◽

Pain Syndrome ◽

Radiofrequency Therapy

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Parental Perceptions of Pediatric Pain and POTS-Related Disability

Clinical Pediatrics ◽

10.1177/0009922816681137 ◽

2016 ◽

Vol 56 (13) ◽

pp. 1185-1192 ◽

Cited By ~ 2

Author(s):

Elizabeth M. Keating ◽

Ryan M. Antiel ◽

Karen E. Weiss ◽

Dustin Wallace ◽

Seth J. Antiel ◽

...

Keyword(s):

Chronic Pain ◽

Functional Impairment ◽

Functional Disability ◽

Clinical Symptoms ◽

Health Condition ◽

Pain Clinic ◽

Postural Orthostatic Tachycardia Syndrome ◽

Parental Attributions ◽

Attribution Questionnaire ◽

Chronic Pain Clinic

Adolescents with postural orthostatic tachycardia syndrome (POTS) often have pain and functional impairment. This study evaluated how parental attributions of children’s symptoms relate to child functional impairment. Adolescents with chronic pain and clinical symptoms suggestive of autonomic dysfunction (fatigue, dizziness, nausea) that attended a multidisciplinary chronic pain clinic completed measures of depression, anxiety, and functioning (n = 141). Parents of 114 of these patients completed the Parent Pain Attribution Questionnaire (PPAQ), a measure indicating the extent they believe physical and psychosocial factors account for their child’s health condition. Patients were retrospectively grouped as to whether or not they had significant POTS on tilt table testing (n = 37). Greater parental attribution to physical causes was associated with increased levels of functional disability whether patients had POTS ( r = 0.45, P = .006) or not ( r = 0.25, P = .03). These results suggest that providers should advocate a more comprehensive family-oriented rehabilitative approach to treatment.

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Wie sinnvoll ist die Zweipunktdiskrimination als diagnostisches Mittel bei der Epicondylopathia humeri radialis?

MSK – Muskuloskelettale Physiotherapie ◽

10.1055/a-1539-2504 ◽

2021 ◽

Vol 25 (04) ◽

pp. 181-189

Author(s):

Kirsten Börms ◽

Michael Richter

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Complex Regional Pain Syndrome ◽

Chronic Low Back Pain ◽

Pain Syndrome ◽

Low Back ◽

Epicondylopathia Humeri Radialis

ZusammenfassungDie diagnostische Aussagekraft der Zweipunktdiskrimination (ZPD) als Indikator für chronische Krankheitsprozesse (z. B. Complex Regional Pain Syndrome, Chronic Low Back Pain) ist mehrfach untersucht und gilt als belegt. Das Ziel der vorliegenden Arbeit war es, die ZPD als diagnostisches Mittel in der Ellenbogenregion zu untersuchen.Mithilfe eines Ästhesiometers (Schieblehre) wurde die ZPD im Bereich des lateralen Ellenbogens bei einer Patientengruppe (N = 21) mit der Diagnose Epicondylopathia humeri radialis sowie einer gesunden Kontrollgruppe (N = 40) mit folgender primärer Fragestellung untersucht: Kann die ZPD am Ellenbogen gesunde Proband(inn)en von Proband(inn)en mit Epicondylopathia humeri radialis unterscheiden? Als Basis wurden ZPD-Normwerte anhand der Kontrollgruppe am lateralen Ellenbogen erstellt. In einer vertiefenden Datenanalyse der Patientenpopulation wurden die Daten der Patient(inn)en mit einem akuten (N = 13) mit den Daten der Patient(inn)en mit einem chronischen (N = 8) Zustand verglichen.Im Ergebnis scheint die ZPD kein geeignetes Diagnostikinstrument zur Differenzierung der Fall- von der Kontrollgruppe sowie von akuten und chronischen Verläufen in der lateralen Ellenbogenregion zu sein.

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Chronic pain syndromes

Oxford Handbook of Rheumatology ◽

10.1093/med/9780198728252.003.0022 ◽

2018 ◽

pp. 623-642

Author(s):

Gavin Clunie ◽

Nick Wilkinson ◽

Elena Nikiphorou ◽

Deepak R. Jadon

Keyword(s):

Chronic Pain ◽

General Practitioner ◽

Children And Adolescents ◽

Complex Regional Pain Syndrome ◽

Musculoskeletal Pain ◽

Pain Syndrome ◽

Pain Syndromes ◽

Pain Medications ◽

Cross Reference ◽

Chronic Pain Syndromes

The Oxford Handbook of Rheumatology 4th edition, has been extensively updated to thoroughly review aspects of musculoskeletal pain. Pain pathophysiology is reviewed. Chronic pain and fibromyalgia in adults and in children and adolescents is dealt with in detail. The reader is advised to cross reference from this chapter to Chapters 1–3 in the Handbook, where regional musculoskeletal pain conditions are listed and reviewed. In localized pain syndromes, the chapter has an overview of complex regional pain syndrome (CRPS), which is not infrequently encountered in rheumatology and musculoskeletal clinics. Included in detail for this edition, is the assessment and management of pain in children, which is a highly specialized clinical area of medicine and will be of use to the adult rheumatologist and general practitioner as well as paediatric specialists. Readers should cross reference to Chapter 23 on medications, for ‘pain medications’ in the Handbook

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Psychological Characteristics in Patients with Chronic Complex Regional Pain Syndrome: Comparisons with Patients with Major Depressive Disorder and Other Types of Chronic Pain

Journal of Pain Research ◽

10.2147/jpr.s230394 ◽

2020 ◽

Vol Volume 13 ◽

pp. 389-398 ◽

Cited By ~ 3

Author(s):

Hye Youn Park ◽

Ye Eun Jang ◽

Sunghee Oh ◽

Pyung Bok Lee

Keyword(s):

Chronic Pain ◽

Major Depressive Disorder ◽

Depressive Disorder ◽

Complex Regional Pain Syndrome ◽

Pain Syndrome ◽

Psychological Characteristics ◽

Major Depressive

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Pain Characteristics and Demographics of Patients Attending a University-Affiliated Pain Clinic in Toronto, Ontario

Pain Research and Management ◽

10.1155/2007/658762 ◽

2007 ◽

Vol 12 (2) ◽

pp. 93-99 ◽

Cited By ~ 23

Author(s):

Angela Mailis-Gagnon ◽

Balaji Yegneswaran ◽

SF Lakha ◽

Keith Nicholson ◽

Amanda J Steiman ◽

...

Keyword(s):

Chronic Pain ◽

Tertiary Care ◽

Pain Clinic ◽

Pain Clinics ◽

Chronic Pain Patients ◽

Musculoskeletal Problems ◽

Pain Duration ◽

Study Population ◽

Age Range ◽

Pain Patients

BACKGROUND: Pain clinics tend to see more complex chronic pain patients than primary care settings, but the types of patients seen may differ among practices.OBJECTIVE: The aim of the present observational study was to describe the pain and demographic characteristics of patients attending a university-affiliated tertiary care pain clinic in Toronto, Ontario.METHODS: Data were collected on 1242 consecutive new patients seen over a three-year period at the Comprehensive Pain Program in central Toronto.RESULTS: Musculoskeletal problems affecting large joints and the spine were the predominant cause of pain (more prevalent in women), followed by neuropathic disorders (more prevalent in men) in patients with recognizable physical pathology. The most affected age group was in the 35- to 49-year age range, with a mean pain duration of 7.8 years before the consultation. While 77% of the Comprehensive Pain Program patients had relevant and detectable physical pathology for pain complaints, three-quarters of the overall study population also had significant associated psychological or psychiatric comorbidity. Women, in general, attended the pain clinic in greater numbers and had less apparent physical pathology than men. Finally, less than one in five patients was employed at the time of referral.CONCLUSIONS: The relevance of the data in relation to other pain clinics is discussed, as well as waiting lists and other barriers faced by chronic pain patients, pain practitioners and pain facilities in Ontario and Canada.

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