Salma M Bakr1, James Knight2, Sarah K Johnson3, Amy E Williams4, James A Tolley5, Jeffrey S Raskin2. 1. Faculty of Medicine, Ain Shams University, Cairo, Egypt. 2. Section of Pediatric Neurosurgery, Department of Neurological Surgery, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A. 3. Section of Physical Therapy, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A. 4. Department of Psychiatry, Riley Child and Adolescent Psychiatry Clinic, Indiana University School of Medicine, Indiana University Health, Indianapolis, Indiana, U.S.A. 5. Section of Pediatric Anesthesia, Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A.
Abstract
BACKGROUND: In the pediatric population, complex regional pain syndrome (CRPS) is a debilitating chronic pain syndrome that is classically treated with escalating polypharmacy and physical therapy. Failure of therapy is often encountered in both adult and pediatric patients with CRPS, after which invasive neuromodulatory therapy might be considered. Intrathecal drug delivery systems and spinal cord stimulation (SCS) have been reported in the literature as forms of neuromodulation effective in adult CRPS; however, SCS remains inadequately researched and underreported in the pediatric CRPS population. Owing to the differences in patient population characteristics and the specific vulnerability of adolescents to drugs that might be used to manage refractory cases, including but not limited to opioids, we believe that early effective pain management without the use of chronic pain medications is of paramount importance. METHODS: Recent evidence suggests that neuromodulation can be useful toward improving function and managing pain, while also reducing medication use in chronic pain patients. A representative case a review of the literature is performed. RESULTS: We report the effective treatment of CRPS in a pediatric patient following implantation of an SCS device typifying the improved pain scores, decreased medication use, and substantially improved functional abilities in pediatric patients following SCS. CONCLUSIONS: The manuscript objective is to stimulate a discussion for SCS use earlier in the therapeutic management of CRPS in children.
BACKGROUND: In the pediatric population, complex regional pain syndrome (CRPS) is a debilitating chronic pain syndrome that is classically treated with escalating polypharmacy and physical therapy. Failure of therapy is often encountered in both adult and pediatric patients with CRPS, after which invasive neuromodulatory therapy might be considered. Intrathecal drug delivery systems and spinal cord stimulation (SCS) have been reported in the literature as forms of neuromodulation effective in adult CRPS; however, SCS remains inadequately researched and underreported in the pediatric CRPS population. Owing to the differences in patient population characteristics and the specific vulnerability of adolescents to drugs that might be used to manage refractory cases, including but not limited to opioids, we believe that early effective pain management without the use of chronic pain medications is of paramount importance. METHODS: Recent evidence suggests that neuromodulation can be useful toward improving function and managing pain, while also reducing medication use in chronic painpatients. A representative case a review of the literature is performed. RESULTS: We report the effective treatment of CRPS in a pediatric patient following implantation of an SCS device typifying the improved pain scores, decreased medication use, and substantially improved functional abilities in pediatric patients following SCS. CONCLUSIONS: The manuscript objective is to stimulate a discussion for SCS use earlier in the therapeutic management of CRPS in children.