Complex Regional Pain Syndrome in Children

Complex regional pain syndrome (CRPS1) or reflex sympathetic dystrophy (RSD) is characterized by severe, nondermatomal, chronic pain, vasoand sudormotor changes, and a movement disorder. It can be preceded by a noxious event, though the presentation is often disproportionate to the inciting injury. A recent population based study (1) did not find any patients under age 10 and only three patients, one male and two females, in the 10 to 19 age group. Thus, the incidence was 1 to 2 per 100,000 person years at risk and the prevalence was less than 1 per 100,000 people. Large medical centers have reported several case series with a total number of approximately 1000 patients in the pediatric age group. There are only a few case reports of children in the preschool years. (2,3,4). The majority of patients presenting for medical care are in the preadolescent and adolescent age groups. Girls are affected 5 times more often than boys. Whereas adults frequently present with symptoms in their upper extremities, in children, lower limbs are affected 5 times more often than upper ones. (5) In the 1980’s it was observed that 11 months passed before a diagnosis of CRPS was made. (5) An increased awareness of the syndrome in children seems to have led to an earlier diagnosis. Particularly in cases with an identifiable injury or after surgical procedures children are often referred to pain clinics with the specific question whether this could be CRPS.