Complex Regional Pain Syndrome (CRPS) Explained: For Teenagers, By Teenagers

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Tara Steward rated it liked it Dec 25, Pam chandler rated it liked it Dec 06, Angie rated it liked it May 12, Gillian Lauder rated it it was amazing Nov 22, Colleen marked it as to-read Aug 03, Mraine marked it as to-read May 11, Kelly marked it as to-read Sep 13, Jess Harrison added it Jan 14, Items are rated on a three-point scale, summed to obtain a total score, then converted to standardized T scores with a mean of 50 and SD of Higher scores indicate higher levels of depressive symptoms. The CDI has been found to have good reliability and validity for children seven to 17 years of age.

Total anxiety scores are calculated by summing all items, with the exception of the lie scale items. Summed scores are then converted to T scores with mean of 50 and SD of Items are coded so that higher scores reflect more frequent passive pain coping. The percentage of completed PRI data for each pain group ranged from The PRI has demonstrated reliability and validity for children and adolescents. Data analyses consisted of comparisons between the CRPS group and the headache, abdominal pain and back pain groups combined, as well as individually.

To examine psychological and physical functioning variables between groups, these variables were analyzed using one-way ANOVAs followed by post hoc least significant difference tests between the CRPS group and each of the other pain groups.

Complex Regional Pain Syndrome Special Needs Factsheet

Demographic and pain-related variables that differed significantly between the CRPS group and other pain groups were included as covariates in the model if they also correlated significantly with the dependent variable. All data were examined to ensure that they met assumptions of normality and were suitable for parametric statistical analyses. All variables met these criteria with the exception of number of school absences, which was not normally distributed and was subsequently analyzed with nonparametric statistical tests.

Among children with CRPS, the vast majority Upper extremity CRPS pain was far less common 7.

Pediatric complex regional pain syndrome: a review

Comparing demographic and pain characteristics of the CRPS group with the other pain groups yielded a number of statistically significant distinctions means and frequencies according to pain group are presented in Table 2. Several differences emerged between the CRPS group and the back pain group that did not differ when children with CRPS were compared with children with headache or abdominal pain. The pain groups did not differ with regard to family history of chronic pain.

There were no group differences in reported rates of using acupuncture for pain treatment. Of the demographic variables that differed among pain groups, those that correlated with the outcome variable for each individual analysis as listed above were included. Pain duration did not correlate with any outcomes of interest and was, therefore, not included in the analyses. No significant difference in school attendance rates emerged between children with CRPS and children with back pain. No significant differences were observed between the CRPS group and any comparison pain diagnostic group.

In the normative sample of to year-old females, a T score of 60 represents the 83rd percentile and a T score of 65 represents the 93rd percentile These percentages are similar to those from the normative comparison sample. Post hoc comparisons revealed that children with CRPS reported more somatic symptoms on the CSI eg, difficulty walking, pains in the arms or legs, weakness, numbness or tingling, pains in the joints than children with headache and back pain; there were no significant differences on the CSI between CRPS and abdominal pain groups.

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There were no significant differences between children with CRPS and any of the comparison groups on the anxiety measure. Post hoc comparisons revealed that children with CRPS reported significantly less passive coping on the PRI than children with headaches; there were no significant differences in passive pain coping between children with CRPS and children with abdominal or back pain. The present study sought to describe a sample of children diagnosed with CRPS using well-validated and accepted diagnostic criteria and to compare this sample with children with other pain conditions in terms of demographic, pain, physical functioning and psychological characteristics using standardized, validated measures.

Results reveal that the vast majority of children with CRPS are female, with an even greater sex disparity in this diagnostic group compared with other pediatric chronic pain conditions. The previously documented lower extremity preponderance in pediatric CRPS 6 , 7 was confirmed in the present study. Relative to other chronic pain conditions seen at our tertiary care pediatric pain clinic, children with CRPS have shorter mean pain duration at the time of referral to a tertiary care pain clinic and report higher current pain severity.

Children with CRPS are more likely to have tried physical therapy and anesthetic block procedures before their initial multidisciplinary evaluation than children with other pain conditions, but are less likely to have pursued psychological treatment compared with children with abdominal pain. It is possible that the longer time since pain onset for the abdominal pain group compared with the CRPS group accounts for their increased previous exposure to psychological treatment. The difference in current reported pain severity between the CRPS group and other diagnostic groups is particularly striking, given that ratings were taken at rest and CRPS pain is exacerbated by touch and movement.

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• Complex Regional Pain Syndrome (CRPS) Explained: For Teenagers, By Teenagers?

Partially confirming the study hypotheses, differences between CRPS and other pain conditions were noted in levels of pain-related disability, with the CRPS group reporting more global functional disability than the other diagnostic groups. Similarly, these children reported more widespread pain and other symptom complaints on the CSI. Because pediatric CRPS typically involves a lower extremity, thus inhibiting ambulation, it is not surprising that daily functional abilities are more impaired in this group.

The greater number of somatic symptoms may be accounted for by the fact that CRPS is considered to entail central pain sensitization and thus may lead to pain and hyperesthesia in other areas of the body over time. However, the alternative explanation, that children with CRPS have heightened levels of hypervigilance to physiological or somatic experiences, cannot be ruled out and merits further investigation In terms of school attendance, the opposite pattern emerged. Children with CRPS reported fewer missed school days than children with headache or abdominal pain, suggesting that even in the face of greater physical disability, children with CRPS as a group report comparatively less school impairment.

This is somewhat surprising because CRPS is typically characterized by constant pain whereas headache and abdominal pain may be intermittent. Perhaps some children with constant pain find ways to function in spite of their ongoing pain, whereas children with episodic pain are more debilitated by their pain episodes. More research is required in this area to understand these patterns. Contrary to the hypothesis, at the group level, children with CRPS reported no greater anxiety or depressive symptoms than children with other pain conditions, with self-reported symptoms within normal limits compared with standardized scores based on normative samples.

In some respects, the CRPS group appears to be less psychologically impaired than children with other types of chronic pain.

Relative to other diagnostic groups in the sample, the CRPS group was less likely to use passive coping strategies eg, pain catastrophizing , which have been demonstrated to be less effective ways of coping with pain 42 , The finding that these children, on average, do not manifest clinically significant psychological distress is consistent with previous research of children with CRPS using standardized assessment tools 36 , and in opposition to studies relying solely on interview and case study methodologies that report elevated levels of psychological impairment 25 , It is clear that group means do not capture the individual variation that undoubtedly exists within the pediatric CRPS population.

Clinical experience suggests that some children with CRPS do, in fact, present with elevated symptoms of depression and anxiety, similar to children with other chronic pain conditions, whereas other children may demonstrate psychological resilience in the face of the challenges of chronic pain. In the setting of a chronic pain clinic where children present with a mean pain duration of one to two years, it is not possible to determine whether this distress, when present, is a cause or consequence of the pain experience, or simply a coexisting condition.

However, these group-level findings provide an important balance against previous case studies and clinical observations that imply a primarily psychological etiology in patients with CRPS. It should be noted that the absence of significant psychological differences between pediatric CRPS patients and patients with other chronic pain conditions in the present study can be interpreted with more confidence than in previous studies due to the relatively large sample size available and the application of rigorous CRPS diagnostic criteria.

Recent work involving adult CRPS patients suggests that the role of psychological factors in the condition may be linked to physiological processes Although results of the current study indicate that children with CRPS may not experience a unique degree of psychological distress compared with children with other chronic pain conditions, this does not necessarily rule out a possible impact of emotional distress on CRPS development, potentially via links between distress and adrenergic mechanisms contributing to CRPS For example, Harden et al 2 found that in adults, greater increases in anxiety and depression in the four weeks following total knee arthroplasty predicted greater levels of CRPS symptoms up to 12 months following surgery.

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In a daily diary study of adults with CRPS, Feldman et al 56 suggest that a transactional relationship exists among pain, emotional distress and social support, such that pain and emotional distress depression, anger, anxiety exacerbate one another, with social support exerting a protective buffering influence.

In a study of brain anatomy using magnetic resonance imaging techniques, Geha et al 57 detected abnormal gray-white matter interactions that could account for both pain and emotional reactions in adults with CRPS. Collectively, these studies suggest that psychological factors are frequently involved in the experience of CRPS among adult patients; however, their role is likely to be complex and is not yet fully understood.

Clearly, more research is needed to understand these associations in the pediatric population. Overall, the findings of the present study support the view that pediatric CRPS is a complex condition that can be best understood and treated through a biopsychosocial framework. These results do not support assertions in some previous reports that the psychological aspects of CRPS are more pronounced than those of other chronic pediatric pain disorders. Certainly, the identification and treatment of psychological concomitants, such as symptoms of depression or anxiety, and of interpersonal factors that can influence the course of the disorder, such as family dynamics and parental responses to pain behaviours, are important goals in managing pediatric CRPS.

However, it is crucial to recognize that although the symptom pictures may overlap, true ie, properly diagnosed CRPS should not be presumed to be a conversion reaction or other psychosomatic disorder but should be viewed as a complex biopsychosocial phenomenon. Consequently, treatment should entail coordinated interdisciplinary efforts that address the biological, physical and psychosocial aspects and sequelae of this complex condition.

The findings of the present study must be evaluated in light of several limitations. First, the study was retrospective and cross-sectional in design. The tertiary clinic-based sample may not be fully representative of the larger population of all children who experience chronic pain. The study is further limited by reliance on self-report assessments of psychological functioning at a single time point, which may be open to social desirability influences, particularly in the setting of a first-time clinical evaluation Although children with CRPS were classified using specific diagnostic criteria, inclusion in the comparison groups did not require adherence to strict diagnostic criteria; therefore, the comparison groups may represent heterogenous conditions with a shared pain location.

Finally, it is important to highlight that the diagnostic criteria for CRPS were developed for adult patient populations and were applied to a pediatric sample in the present study because no pediatric criteria have been developed. These criteria may be overly stringent for use with children. Further work is needed to advance our understanding of pediatric CRPS. Prospective longitudinal studies, particularly those that capture a wide sample of children before some develop CRPS, could provide valuable additional insight into the interplay and causal relations of psychological and biological influences on the condition over time.

Clinically, much remains unknown regarding this complex chronic pain condition. However, it is hoped that studies such as this will lead to the thorough and accurate assessment and treatment of CRPS by clarifying to medical and mental health practitioners alike that CRPS is a complex chronic pain experience, the maintenance and expression of which are influenced by many individual and environmental factors.

Careful diagnosis and evaluation of children with symptoms of CRPS and the provision of treatments to address the multiple biopsychosocial facets of this complex condition are crucial tasks facing pediatric psychologists and other health care providers who encounter this challenging pain condition. National Center for Biotechnology Information , U.

Journal List Pain Res Manag v. Author information Copyright and License information Disclaimer. Telephone , fax , e-mail ude. This article has been cited by other articles in PMC. Chronic pain, Complex regional pain syndrome, Functional disability, Pediatric, Psychological functioning. Procedure The present study entailed a retrospective chart review. To make the clinical diagnosis of CRPS, the following criteria must be met: Please verify that you are not a robot. Would you also like to submit a review for this item? You already recently rated this item. Your rating has been recorded.

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