Canadian surveillance study of complex regional pain syndrome in children

Canadian surveillance study of complex regional pain syndrome in children

Baerg KL; Tupper SM; Chu LM; Cooke N; Dick BD; Doré-Bergeron MJ; Findlay S; Ingelmo PM; Lamontagne C; Mesaroli G; Oberlander T; Poolacherla R; Spencer AO; Stinson J; Finley GA

PAIN

2021

Complex Regional Pain Syndrome; Incidence; Pain Management; Pediatrics; Population Surveillance

This study describes the minimum incidence of pediatric complex regional pain syndrome (CRPS), clinical features, and treatments recommended by pediatricians and pain clinics in Canada. Participants in the Canadian Paediatric Surveillance Program (CPSP) reported new cases of CRPS aged 2-18 years monthly and completed a detailed case reporting questionnaire from September 2017 to August 2019. Descriptive analysis was completed and the annual incidence of CRPS by sex and age groupings was estimated. A total of 198 cases were reported to CPSP, 168 (84.8%) met the case definition. The minimum Canadian incidence of CRPS is estimated at 1.14/100 000 (95% CI 0.93 to 1.35/100 000) children per year. Incidence was highest among females 12 years and older (3.10, 95% CI 2.76 to 3.44/100 000). Mean age of CRPS diagnosis was 12.2 years (SD=2.4) with mean time from symptom onset to diagnosis of 5.6 months (SD=9.9) and no known inciting event for 19.6% of cases. The majority of cases had lower limb involvement (79.8%). Nonsteroidal anti-inflammatory drugs (82.7%) and acetaminophen (66.0%) were prescribed more commonly than antiepileptic drugs (52.3%) and antidepressants (32.0%). Referrals most commonly included physical therapy (83.3%) and multidisciplinary pain clinics (72.6%); a small number of patients withdrew from treatment due to pain exacerbation (5.3%). Pain education was recommended for only 65.6% of cases. Treatment variability highlights the need for empiric data to support treatment of pediatric CRPS and development of treatment consensus guidelines.

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