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Good News For Children with Complex Regional Pain Syndrome

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Physical Therapy in Cleburne for Pediatric Issues

Children with a condition called complex regional pain syndrome or CRPS often suffer intense pain and swelling of the affected arm and hand or leg and foot. They often experience skin changes (color, texture, hair growth, temperature). The net result is a loss of motion and function along with reduced quality of life. If the condition becomes chronic, dystrophy or deterioration of the bones and muscles in the affected body part may occur.

CRPS occurs most often after an injury as minor as having blood drawn, or a sprained ankle. Other times, it may be the result of a more significant injury such as surgery, a fracture, immobilization with casting or splinting, or in adults, as a result of a stroke.

Risk factors for developing CRPS include immobilization of the affected limb with a cast, splint or sling; smoking; genetics; and psychological factors. The problem is not understood very well. Doctors don't really know what causes it or why it happens. That makes CRPS a difficult condition to treat effectively.

But a team of health care professionals at Denver Children's Hospital have some good news. Using a team approach, they have developed a step-by-step plan for the treatment of CRPS in children that is having good success. They start with a review of all the ways the child has already been treated so far. Most often, medications have been prescribed and the child has worked with a Physical Therapist.

When previous medications (usually pain relievers and/or antiinflammatories) have not worked, a second line of drugs to try are muscle relaxants and anticonvulsants. The child goes back to Physical Therapy for a more aggressive approach. Failure to achieve pain relief and return of function with these measures results in a referral for a sympathetic (nerve) block.

If the nerve block works, then great! But if it only provides temporary relief from pain, at least it's clear that the team is on the right track. Inpatient hospitalization is recommended. That's when the multidisciplinary team gets to work.

The surgeon provides a continuous block to the nerve while the Physical Therapist works with the child in a total program of sensory modulation, postural alignment, desensitization, motion and movement training and strengthening (as appropriate). During this five-day intense in-patient treatment, a psychologist also offers psychological therapy and behavioral training.

What have the results been so far with this approach? Although their test group was small (37 children under the age of 18), 80 per cent (30 of the 37) were completely cured -- no more pain and swelling, no more disabling symptoms.

A closer look at how each child responded as they went along showed that 10 per cent only needed a single nerve block. Another 10 per cent got better with a change in medication and return to Physical Therapy. That group didn't need the nerve block. The remaining children finished the full program and gradually experienced improvement and complete resolution of symptoms.

There were two other important finding in this study. The first was the fact that children who responded to the nerve block were still in the first few months of this condition. Children who had CRPS for an average of 22 months when they got their first nerve block were less likely to have a good result. And second, three-fourths of the children were girls. Scientists may want to focus future research on understanding the reason for that. If there is a hormonal imbalance, then perhaps treatment can include some way to address this issue.

For now, the authors share their treatment approach for those who have not yet reached an understanding of the benefits of a multidisciplinary protocol for pediatric complex regional pain syndrome (CRPS).

Reference: David Wild. Multidisciplinary Approach Important in Pediatric CRPS. In Pain Medicine News. January 2011. Vol. 9. No. 1. Pp. 15.

realPerformance Physical Therapy provides services for Physical Therapy in Cleburne.

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