Complex Regional Pain Syndrome

Complex regional pain syndrome, also known as reflex sympathetic dystrophy, is a condition that usu­ally involves one limb and more commonly the lower extremity in children.

Clinical Characteristics.

Diagnostics. Unlike adults, who usually have an inciting event such as a fracture, surgery, prolonged immobilization, or vascular insult, children usually do not have a clear event that precipitates the condi­tion (366). There appears to be a sympathetic nervous system reflex arc mechanism of action. The major­ity of children with this condition are teenage girls around 12-13 years of age. Radiographs are useful to rule out a fracture or osteomyelitis (367). Regional nerve blocks may be both diagnostic and therapeu­tic. The diagnosis should be considered with trauma and pain that is out of proportion to the stimulus and worsened with use.

Treatment. A multidisciplinary approach is useful. The earlier the recognition and treatment, the more rap­idly recovery is possible. Once contractures and atro­phy set in, this is a much more difficult entity to treat. Some advocate medications such as calcium channel blockers, beta blockers (propranolol), and tricyclic antidepressants such as amitriptyline.