Spinal Treatment Useful for Painful Syndrome in Children?
CRPS-I is a painful and debilitating disease that affects both children and adults. There exists many treatments that can be used to treat patients affected by CRPS-I. SCS is an established therapy used as a last resort for patients who are resistant to all other treatments however it has currently only been tested for use on adults. This study tested whether SCS is an effective treatment for children and adolescents with CRPS-I.
7 Dec 2007In a recent issue of the European Journal of Pain, spinal cord stimulation (SCS) was tested as a treatment for Complex Regional Pain Syndrome type I (CRPS-I) in adolescents resistant to normal treatment. CRPS-I is not uncommon in children, particularly in adolescent girls 11-14 years of age. This is a debilitating condition characterized by severe pain that occurs either spontaneously or due to touch. It commonly involves a foot and usually occurs near a previous injury, although sometimes no reasonable cause can be identified. Typical treatment includes active movements and physical therapy, drugs, psychological therapy (including cognitive behaviour therapy) and sympathetic blocks. For the small number of patients resistant to these treatments, SCS may be their last resort.
SCS is an established therapy for CRPS-I which has previously only been used on adults. This investigation looked at whether SCS would be an effective treatment in children and adolescents with CRPS-I.
This study examined the history of seven girls 11-14 years of age with CRPS-I treated with SCS. The girls were all selected for SCS treatment during 1994-2004 after failing to respond to intensive treatment. Before SCS, they were treated with physiotherapy, analgesics, sympathetic blocks and other drugs without success. After SCS surgery, the patients were examined and interviewed. The outcome after SCS was measured through testing of spontaneous pain, allodynia, ability to bear weight, pain at bearing weight, dysautonomic signs, sensitivity to cold, analgesic consumption, and school attendance. A final follow up interview was conducted by telephone in the spring of 2006.
All of the patients benefited: five had complete pain relief, and the other two had partial but useful pain reduction. It was also found that the length of time between developing CRPS-I and receiving SCS treatment had no effect on the outcome. As patients were staying at home during the trial period, they failed to regularly self-evaluate themselves as instructed. The investigators then had to rely on the patients' and parents' unstructured evaluations. This information included whether or not they were able to put load on the affected foot and/or resume walking with or without crutches, as well as their ability to resume school attendance.
The benefit from SCS usually began after 1-2 weeks, continuing until the pain was completely suppressed after another 2-3 weeks. The level of allodynia was hard to assess, as the patients were initially very hypersensitive and unable to bear the extreme pain felt during examination.
These patients had extreme and severe forms of CRPS-I and all of them had failed to benefit from other treatments. As such, the chance of the disease naturally curing itself was considered to be less likely than usual. Two cases were found to have major psychological/psychosocial problems that were important in the generation and continuation of the pain condition. Nevertheless, both cases benefited from the SCS treatment.
As previously mentioned, SCS has not previously been tried in children. From the experience of this study it is believed that SCS can also be a useful treatment for severely incapacitated paediatric cases that are otherwise resistant to standard therapy. As this study was small and without strong design controls, further studies are required to confirm that SCS can be recommended for both children and adolescents.
(Source: Olsson GL, Meyerson BA, Linderoth B. Spinal cord stimulation in adolescents with complex regional pain syndrome type I (CRPS-I). European Journal of Pain 2007. : December 2007)
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