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Aktuelle Rheumatologie 2016; 41(04): 316-325
DOI: 10.1055/s-0042-105742
Übersichtsarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Das komplexe regionale Schmerzsyndrom (CRPS) bei Kindern und Jugendlichen

Complex Regional Pain Syndrome (CRPS) in Children and Adolescents
N. Draheim
1   Deutsches Zentrum für Kinder- und Jugendrheumatologie, Zentrum für Schmerztherapie junger Menschen, Lehrkrankenhaus der LMU München, Garmisch-Partenkirchen
,
L. Hoefel
1   Deutsches Zentrum für Kinder- und Jugendrheumatologie, Zentrum für Schmerztherapie junger Menschen, Lehrkrankenhaus der LMU München, Garmisch-Partenkirchen
,
E. Schnoebel-Mueller
1   Deutsches Zentrum für Kinder- und Jugendrheumatologie, Zentrum für Schmerztherapie junger Menschen, Lehrkrankenhaus der LMU München, Garmisch-Partenkirchen
,
J.-P. Haas
1   Deutsches Zentrum für Kinder- und Jugendrheumatologie, Zentrum für Schmerztherapie junger Menschen, Lehrkrankenhaus der LMU München, Garmisch-Partenkirchen
› Institutsangaben
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Publikationsverlauf

Publikationsdatum:
31. August 2016 (online)

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Zusammenfassung

Zunehmend häufig werden Kinder und Jugendliche mit lokalisierten oder generalisierten muskuloskelettalen Schmerzen (kinder-)rheumatologisch vorgestellt, ohne dass eine zugrunde liegende rheumatologische Erkrankung diagnostiziert werden kann. Differenzialdiagnostisch müssen Schmerzerkrankungen bedacht werden. Eine lokalisierte chronische Schmerzsymptomatik ist seltener zu finden als die generalisierte Form. Vor allem das komplexe regionale Schmerzsyndrom (complex regional pain syndrome, CRPS) weist bei Kindern und Jugendlichen im Vergleich zum Erwachsenenalter einige Besonderheiten, nicht zuletzt bezüglich Behandlung und Prognose auf. Multimodale Therapieprogramme haben gute Erfolgsaussichten, die Therapie sollte zeitnah durch pädiatrisch und schmerztherapeutisch erfahrene Behandler erfolgen, um eine Chronifizierung zu vermeiden.

Abstract

An increasing number of children and adolescents are seen by (paediatric) rheumatologists with symptoms of localised or generalised musculoskeletal pain without any underlying rheumatic disease. In this context, pain disorders are potential differential diagnoses. In patients presenting with chronic localised pain, which is rather rare compared to generalised pain, a complex regional pain syndrome (CRPS) has to be considered. In comparison to adults there are some differences in paediatric CRPS, especially regarding treatment and prognosis. Multimodal treatment programs offer good chances of success. This treatment should be rapidly initiated by paediatric pain specialists to avoid a chronic course.

Schlüsselwörter

Komplexes regionales Schmerzsyndrom - Kinder und Jugendliche - Multimodale Therapie - CRPS - Chronische Schmerzen

Key words

CRPS - complex regional pain syndrome - children and adolescents - chronic pain - multimodal treatment
 

  • Literatur

  • 1 Stanton-Hicks M, Janig W, Hassenbusch S et al. Reflex sympathetic dystrophy: changing concepts and taxonomy. Pain 1995; 63: 127-133
    CrossrefPubMedGoogle Scholar
  • 2 Sandroni P, Benrud-Larson LM, McClelland RL et al. Complex regional pain syndrome type I: incidence and prevalence in Olmsted county, a population-based study. Pain 2003; 103: 199-207
    CrossrefPubMedGoogle Scholar
  • 3 de Mos M, de Bruijn AG, Huygen FJ et al. The incidence of complex regional pain syndrome: a population-based study. Pain 2007; 129: 12-20
    CrossrefPubMedGoogle Scholar
  • 4 Birklein Fea . Diagnostik und Therapie komplexer regionaler Schemrzsndrome (CRPS). Im Internet: http://www.awmf.org/leitlinien/detail/ll/030-116.html
    PubMedGoogle Scholar
  • 5 Maihofner C, Seifert F, Markovic K. Complex regional pain syndromes: new pathophysiological concepts and therapies. Eur J Neurol 2010; 17: 649-660
    CrossrefPubMedGoogle Scholar
  • 6 Marinus J, Moseley GL, Birklein F et al. Clinical features and pathophysiology of complex regional pain syndrome. Lancet Neurol 2011; 10: 637-648
    CrossrefPubMedGoogle Scholar
  • 7 Harris EJ, Schimka KE, Carlson RM. Complex regional pain syndrome of the pediatric lower extremity: a retrospective review. J Am Podiatr Med Assoc 2012; 102: 99-104
    CrossrefPubMedGoogle Scholar
  • 8 Tan EC, Zijlstra B, Essink ML et al. Complex regional pain syndrome type I in children. Acta Paediatr 2008; 97: 875-879
    CrossrefPubMedGoogle Scholar
  • 9 Low AK, Ward K, Wines AP. Pediatric complex regional pain syndrome. J Pediatr Orthop 2007; 27: 567-572
    CrossrefPubMedGoogle Scholar
  • 10 Draheim N, Jäger N, JP H. Komplexes regionales Schmerzsyndrom bei Kindern und Jugendlichen. Trauma und Berufskrankheit 2015; DOI: 10.1007/s10039-015-0058-9:1-5.
    PubMedGoogle Scholar
  • 11 Jäger NHB, Wollesen E et al. Pain and functional impairment in children with complex regional pain syndrome compared to generalized chronic pain at presentation and 12 month follow up. Annals of the Rheumatic Diseases 2015; 74: 311
    PubMedGoogle Scholar
  • 12 Wilder RT. Management of pediatric patients with complex regional pain syndrome. The Clinical journal of pain 2006; 22: 443-448
    CrossrefPubMedGoogle Scholar
  • 13 Stanton-Hicks M. Plasticity of complex regional pain syndrome (CRPS) in children. Pain Med 2010; 11: 1216-1223
    CrossrefPubMedGoogle Scholar
  • 14 Tan EC, van de Sandt-Renkema N, Krabbe PF et al Quality of life in adults with childhood-onset of Complex Regional Pain Syndrome type I. Injury 2009; 40: 901-904
    CrossrefPubMedGoogle Scholar
  • 15 Maier C, Baron R, Tolle TR et al. Quantitative sensory testing in the German Research Network on Neuropathic Pain (DFNS): somatosensory abnormalities in 1236 patients with different neuropathic pain syndromes. Pain 2010; 150: 439-450
    CrossrefPubMedGoogle Scholar
  • 16 Birklein F, Riedl B, Claus D et al. Pattern of autonomic dysfunction in time course of complex regional pain syndrome. Clin Auton Res 1998; 8: 79-85
    CrossrefPubMedGoogle Scholar
  • 17 McCabe CS, Shenker N, Lewis J et al. Impaired self-perception of the hand in complex regional pain syndrome (CRPS) [S. Forderreuther, U. Sailer, A. Straube, Pain 2004; 110:756-761]. Pain 2005; 114: 518 author reply 519
    CrossrefPubMedGoogle Scholar
  • 18 Alexander GM, Peterlin BL, Perreault MJ et al. Changes in plasma cytokines and their soluble receptors in complex regional pain syndrome. J Pain 2012; 13: 10-20
    CrossrefPubMedGoogle Scholar
  • 19 Birklein F, Schmelz M. Neuropeptides, neurogenic inflammation and complex regional pain syndrome (CRPS). Neurosci Lett 2008; 437: 199-202
    CrossrefPubMedGoogle Scholar
  • 20 Nickel F, Maihofner C. Aktuelle Erkenntnisse zur Pathophysiologie des CRPS 1. HAndchir Mikrochir Plast Chir 2010; 42: 8-14
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 21 Maihofner C, Handwerker HO, Neundorfer B et al. Patterns of cortical reorganization in complex regional pain syndrome. Neurology 2003; 61: 1707-1715
    CrossrefPubMedGoogle Scholar
  • 22 Maihofner C, Handwerker HO, Neundorfer B et al. Cortical reorganization during recovery from complex regional pain syndrome. Neurology 2004; 63: 693-701
    CrossrefPubMedGoogle Scholar
  • 23 Lebel A, Becerra L, Wallin D et al. fMRI reveals distinct CNS processing during symptomatic and recovered complex regional pain syndrome in children. Brain 2008; 131: 1854-1879
    CrossrefPubMedGoogle Scholar
  • 24 Beerthuizen A, van't Spijker A, Huygen FJ et al. Is there an association between psychological factors and the Complex Regional Pain Syndrome type 1 (CRPS1) in adults? A systematic review. Pain 2009; 145: 52-59
    CrossrefPubMedGoogle Scholar
  • 25 Frettloh J, Maier C, Gockel H et al. Validation of the German Mainz Pain Staging System in different pain syndromes. Schmerz 2003; 17: 240-251
    CrossrefPubMedGoogle Scholar
  • 26 Wager J, Brehmer H, Hirschfeld G et al. Psychological distress and stressful life events in pediatric complex regional pain syndrome. Pain Res Manag 2015; 20: 189-194
    PubMedGoogle Scholar
  • 27 Logan DE, Williams SE, Carullo VP et al. Children and adolescents with complex regional pain syndrome: more psychologically distressed than other children in pain?. Pain Res Manag 2013; 18: 87-93
    PubMedGoogle Scholar
  • 28 Maihofner C. Complex regional pain syndrome: A current review. Schmerz 2014; 28: 319-336 quiz 337-318
    CrossrefPubMedGoogle Scholar
  • 29 Harden RN, Bruehl S, Perez RS et al. Validation of proposed diagnostic criteria (the „Budapest Criteria“) for Complex Regional Pain Syndrome. Pain 2010; 150: 268-274
    CrossrefPubMedGoogle Scholar
  • 30 Peltz E, Seifert F, Maihofner C et al. Diagnostic guidelines for complex regional pain syndrome. Handchir Mikrochir Plast Chir 2012; 44: 135-141
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 31 Crozier F, Champsaur P, Pham T et al. Magnetic resonance imaging in reflex sympathetic dystrophy syndrome of the foot. Joint Bone Spine 2003; 70: 503-508
    CrossrefPubMedGoogle Scholar
  • 32 Ringer R, Wertli M, Bachmann LM et al. Concordance of qualitative bone scintigraphy results with presence of clinical complex regional pain syndrome 1: meta-analysis of test accuracy studies. Eur J Pain 2012; 16: 1347-1356
    CrossrefPubMedGoogle Scholar
  • 33 Schurmann M, Zaspel J, Lohr P et al. Imaging in early posttraumatic complex regional pain syndrome: a comparison of diagnostic methods. The Clinical journal of pain 2007; 23: 449-457
    CrossrefPubMedGoogle Scholar
  • 34 Krumova EK, Frettloh J, Klauenberg S et al. Long-term skin temperature measurements – a practical diagnostic tool in complex regional pain syndrome. Pain 2008; 140: 8-22
    CrossrefPubMedGoogle Scholar
  • 35 Rommel O, Malin JP, Zenz M et al. Quantitative sensory testing, neurophysiological and psychological examination in patients with complex regional pain syndrome and hemisensory deficits. Pain 2001; 93: 279-293
    CrossrefPubMedGoogle Scholar
  • 36 Christensen K, Jensen EM, Noer I. The reflex dystrophy syndrome response to treatment with systemic corticosteroids. Acta Chir Scand 1982; 148: 653-655
    PubMedGoogle Scholar
  • 37 Kalita J, Vajpayee A, Misra UK. Comparison of prednisolone with piroxicam in complex regional pain syndrome following stroke: a randomized controlled trial. QJM 2006; 99: 89-95
    CrossrefPubMedGoogle Scholar
  • 38 Perez RS, Zuurmond WW, Bezemer PD et al. The treatment of complex regional pain syndrome type I with free radical scavengers: a randomized controlled study. Pain 2003; 102: 297-307
    CrossrefPubMedGoogle Scholar
  • 39 Zuurmond WW, Langendijk PN, Bezemer PD et al. Treatment of acute reflex sympathetic dystrophy with DMSO 50% in a fatty cream. Acta Anaesthesiol Scand 1996; 40: 364-367
    CrossrefPubMedGoogle Scholar
  • 40 Brunner F, Schmid A, Kissling R et al. Biphosphonates for the therapy of complex regional pain syndrome I – systematic review. Eur J Pain 2009; 13: 17-21
    CrossrefPubMedGoogle Scholar
  • 41 Manicourt DH, Brasseur JP, Boutsen Y et al. Role of alendronate in therapy for posttraumatic complex regional pain syndrome type I of the lower extremity. Arthritis and rheumatism 2004; 50: 3690-3697
    CrossrefPubMedGoogle Scholar
  • 42 Perez RS, Kwakkel G, Zuurmond WW et al. Treatment of reflex sympathetic dystrophy (CRPS type 1): a research synthesis of 21 randomized clinical trials. J Pain Symptom Manage 2001; 21: 511-526
    CrossrefPubMedGoogle Scholar
  • 43 van de Vusse AC, Stomp-van den Berg SG, Kessels AH et al. Randomised controlled trial of gabapentin in Complex Regional Pain Syndrome type 1 [ISRCTN84121379]. BMC neurology 2004; 4: 13
    CrossrefPubMedGoogle Scholar
  • 44 Sigtermans MJ, van Hilten JJ, Bauer MC et al. Ketamine produces effective and long-term pain relief in patients with Complex Regional Pain Syndrome Type 1. Pain 2009; 145: 304-311
    CrossrefPubMedGoogle Scholar
  • 45 Schwartzman RJ, Alexander GM, Grothusen JR et al. Outpatient intravenous ketamine for the treatment of complex regional pain syndrome: a double-blind placebo controlled study. Pain 2009; 147: 107-115
    CrossrefPubMedGoogle Scholar
  • 46 Goebel A, Baranowski A, Maurer K et al. Intravenous immunoglobulin treatment of the complex regional pain syndrome: a randomized trial. Ann Intern Med 2010; 152: 152-158
    CrossrefPubMedGoogle Scholar
  • 47 Miclescu AA, Nordquist L, Hysing EB et al. Targeting oxidative injury and cytokines' activity in the treatment with anti-tumor necrosis factor-alpha antibody for complex regional pain syndrome 1. Pain Pract 2013; 13: 641-648
    CrossrefPubMedGoogle Scholar
  • 48 Oerlemans HM, Oostendorp RA, de Boo T et al. Pain and reduced mobility in complex regional pain syndrome I: outcome of a prospective randomised controlled clinical trial of adjuvant physical therapy versus occupational therapy. Pain 1999; 83: 77-83
    CrossrefPubMedGoogle Scholar
  • 49 McCabe CS, Haigh RC, Ring EF et al. A controlled pilot study of the utility of mirror visual feedback in the treatment of complex regional pain syndrome (type 1). Rheumatology (Oxford) 2003; 42: 97-101
    CrossrefPubMedGoogle Scholar
  • 50 Moseley GL. Graded motor imagery is effective for long-standing complex regional pain syndrome: a randomised controlled trial. Pain 2004; 108: 192-198
    CrossrefPubMedGoogle Scholar
  • 51 Moseley GL. Graded motor imagery for pathologic pain: a randomized controlled trial. Neurology 2006; 67: 2129-2134
    CrossrefPubMedGoogle Scholar
  • 52 Robaina FJ, Rodriguez JL, de Vera JA et al. Transcutaneous electrical nerve stimulation and spinal cord stimulation for pain relief in reflex sympathetic dystrophy. Stereotact Funct Neurosurg 1989; 52: 53-62
    CrossrefPubMedGoogle Scholar
  • 53 Lee BH, Scharff L, Sethna NF et al. Physical therapy and cognitive-behavioral treatment for complex regional pain syndromes. The Journal of pediatrics 2002; 141: 135-140
    CrossrefPubMedGoogle Scholar
  • 54 Bruehl S, Chung OY. Psychological and behavioral aspects of complex regional pain syndrome management. The Clinical journal of pain 2006; 22: 430-437
    CrossrefPubMedGoogle Scholar
  • 55 Stanton TR, Wand BM, Carr DB et al. Local anaesthetic sympathetic blockade for complex regional pain syndrome. Cochrane Database Syst Rev 2013; 8: CD004598
    PubMedGoogle Scholar
  • 56 Kemler MA, de Vet HC, Barendse GA et al. Effect of spinal cord stimulation for chronic complex regional pain syndrome Type I: five-year final follow-up of patients in a randomized controlled trial. J Neurosurg 2008; 108: 292-298
    CrossrefPubMedGoogle Scholar
  • 57 Kemler MA, Barendse GA, van Kleef M et al. Pain relief in complex regional pain syndrome due to spinal cord stimulation does not depend on vasodilation. Anesthesiology 2000; 92: 1653-1660
    CrossrefPubMedGoogle Scholar
  • 58 Kemler MA, de Vet HC, Barendse GA et al. Spinal cord stimulation for chronic reflex sympathetic dystrophy – five-year follow-up. N Engl J Med 2006; 354: 2394-2396
    CrossrefPubMedGoogle Scholar
  • 59 Barbier O, Allington N, Rombouts JJ. Reflex sympathetic dystrophy in children: review of a clinical series and description of the particularities in children. Acta orthopaedica Belgica 1999; 65: 91-97
    PubMedGoogle Scholar
  • 60 Becerra L, Sava S, Simons LE et al. Intrinsic brain networks normalize with treatment in pediatric complex regional pain syndrome. NeuroImage Clinical 2014; 6: 347-369
    CrossrefPubMedGoogle Scholar
  • 61 Bernstein BH, Singsen BH, Kent JT et al. Reflex neurovascular dystrophy in childhood. The Journal of pediatrics 1978; 93: 211-215
    CrossrefPubMedGoogle Scholar
  • 62 Brooke V, Janselewitz S. Outcomes of children with complex regional pain syndrome after intensive inpatient rehabilitation. PM & R: the journal of injury, function, and rehabilitation 2012; 4: 349-354
    CrossrefPubMedGoogle Scholar
  • 63 Dadure C, Motais F, Ricard C et al. Continuous peripheral nerve blocks at home for treatment of recurrent complex regional pain syndrome I in children. Anesthesiology 2005; 102: 387-391
    CrossrefPubMedGoogle Scholar
  • 64 Dietz FR, Mathews KD, Montgomery WJ. Reflex sympathetic dystrophy in children. Clinical orthopaedics and related research 1990; DOI: 225-231.
    PubMedGoogle Scholar
  • 65 Dietz FR, Compton SP. Outcomes of a Simple Treatment for Complex Regional Pain Syndrome Type I in Children. The Iowa orthopaedic journal 2015; 35: 175-180
    PubMedGoogle Scholar
  • 66 Kachko L, Efrat R, Ben Ami S et al. Complex regional pain syndromes in children and adolescents. Pediatr Int 2008; 50: 523-527
    CrossrefPubMedGoogle Scholar
  • 67 Kesler RW, Saulsbury FT, Miller LT et al. Reflex sympathetic dystrophy in children: treatment with transcutaneous electric nerve stimulation. Pediatrics 1988; 82: 728-732
    PubMedGoogle Scholar
  • 68 Logan DE, Carpino EA, Chiang G et al. A day-hospital approach to treatment of pediatric complex regional pain syndrome: initial functional outcomes. The Clinical journal of pain 2012; 28: 766-774
    CrossrefPubMedGoogle Scholar
  • 69 Maillard SM, Davies K, Khubchandani R et al. Reflex sympathetic dystrophy: a multidisciplinary approach. Arthritis and rheumatism 2004; 51: 284-290
    CrossrefPubMedGoogle Scholar
  • 70 Meier PM, Alexander ME, Sethna NF et al. Complex regional pain syndromes in children and adolescents: regional and systemic signs and symptoms and hemodynamic response to tilt table testing. The Clinical journal of pain 2006; 22: 399-406
    CrossrefPubMedGoogle Scholar
  • 71 Meier PM, Zurakowski D, Berde CB et al. Lumbar sympathetic blockade in children with complex regional pain syndromes: a double blind placebo-controlled crossover trial. Anesthesiology 2009; 111: 372-380
    CrossrefPubMedGoogle Scholar
  • 72 Murray CS, Cohen A, Perkins T et al. Morbidity in reflex sympathetic dystrophy. Archives of disease in childhood 2000; 82: 231-233
    CrossrefPubMedGoogle Scholar
  • 73 Olsson GL, Meyerson BA, Linderoth B. Spinal cord stimulation in adolescents with complex regional pain syndrome type I (CRPS-I). Eur J Pain 2008; 12: 53-59
    CrossrefPubMedGoogle Scholar
  • 74 Petje G, Radler C, Aigner N et al. Treatment of reflex sympathetic dystrophy in children using a prostacyclin analog: preliminary results. Clinical orthopaedics and related research 2005; DOI: 178-182.
    PubMedGoogle Scholar
  • 75 Sherry DD, Wallace CA, Kelley C et al. Short- and long-term outcomes of children with complex regional pain syndrome type I treated with exercise therapy. The Clinical journal of pain 1999; 15: 218-223
    CrossrefPubMedGoogle Scholar
  • 76 Stanton RP, Malcolm JR, Wesdock KA et al. Reflex sympathetic dystrophy in children: an orthopedic perspective. Orthopedics 1993; 16: 773-779 discussion 779-780
    PubMedGoogle Scholar
  • 77 Wesdock KA, Stanton RP, Singsen BH. Reflex sympathetic dystrophy in children. A physical therapy approach. Arthritis care and research: the official journal of the Arthritis Health Professions Association 1991; 4: 32-38
    CrossrefPubMedGoogle Scholar
  • 78 Wilder RT, Berde CB, Wolohan M et al. Reflex sympathetic dystrophy in children. Clinical characteristics and follow-up of seventy patients. J Bone Joint Surg Am 1992; 74: 910-919
    PubMedGoogle Scholar
  • 79 Tronnier V. Neuromodulation for neuropathic pain. Schmerz 2014; 28: 417-430 quiz 431-412
    CrossrefPubMedGoogle Scholar
  • 80 Zernikow B, Wager J, Brehmer H et al. Invasive treatments for complex regional pain syndrome in children and adolescents: a scoping review. Anesthesiology 2015; 122: 699-707
    CrossrefPubMedGoogle Scholar