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An update on complex regional pain syndromes in children and adolescents

Borucki, Amber N.; Greco, Christine D.

doi: 10.1097/MOP.0000000000000250
ADOLESCENT MEDICINE: Edited by Sara F. Forman Sarah Pitts

Purpose of review Complex regional pain syndrome (CRPS) is a chronic pain condition typically involving a limb, which is characterized by neuropathic pain, sensory abnormalities and neurovascular findings. The exact cause of CRPS is unknown; however, proposed theories include alterations in the sympathetic and central nervous system (CNS), small fibre changes in the peripheral nervous system and psychological factors. Although this condition was previously considered rare among children and adolescents, it has been increasingly recognized in paediatric patients and can result in significant disability.

Recent findings The diagnosis of paediatric CRPS is based upon clinical criteria obtained from a thorough history and physical examination. Other possible causes, such as orthopaedic, infectious, vascular and rheumatologic disorders, should be ruled out prior to making the diagnosis. Treatment focuses on a rehabilitative strategy consisting of physical therapy, occupational therapy and cognitive-behavioural therapy with an overall focus on return to functioning.

Summary CRPS in children and adolescents is characterized by a painful, mottled appearing, swollen limb with allodynia and hyperalgesia. For most patients, pain is severe, resulting in significant functional disability. More recent evidence suggests that a rehabilitative programme results in improvement in both pain and functional measures.

Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, and Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts, USA

Correspondence to Christine D. Greco, MD, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, 300 Longwood Avenue, BCH 3120 Boston, MA 02115, USA. Tel: +1 617 355-7040; e-mail:

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