PRESTIGIOUS PUBLICATION TALKS ABOUT CRPS AND SCRAMBER THERAPY
Narrative Review
Noninvasive Treatments for Pediatric Complex Regional Pain Syndrome: A Focused Review
Benjamin R. Katholi, MD, Suzanne S. Daghstani, MS, OTR/L, Gerard A. Banez, PhD, Kimberly K. Brady, MSI
This is a review of current literature of noninvasive treatments for pediatric complex regional pain syndrome (CRPS). There are a variety of noninvasive approaches to the treatment of pain, but few pediatric-focused studies have been published in regard to CRPS. In comparison with adult CRPS, there is a greater need for behavioral approaches in children to enable coping with dif?cult symptoms. Current gaps in knowledge include mechanisms triggering CRPS, pediatric-focused diagnostic criteria, validated tests that are diagnostically speci?c, de?nitive treatment protocols, age-based medication recommen- dations, and validation of speci?c noninvasive treatments in pediatric populations. Intensive multidisciplinary treatment is supported by high recovery rates and a family- centered approach that allows continuation of goals into the community environment.
INTRODUCTION
The purpose of this article is to review evidence for noninvasive treatments for pediatric complex regional pain syndrome (CRPS). In general, much of the treatment for pediatric CRPS has historically been extrapolated from the adult literature. Pediatric CRPS can often be treated using noninvasive methods [1]. CRPS can be separated into 2 categories: type I and type II [2]. Type I typically arises from a minor injury (sprain/fracture), and type II indicates the likelihood of a speci?c nerve injury causing the symptoms [2].
Pediatric CRPS type I develops more commonly in girls of white ethnicity, with the incidence rising around puberty [1,3]. This condition often arises after minor trauma and is more common in the lower extremities (versus upper extremity in adults) [1,3]. CPRS type II has been reported to occur in equal numbers in boys and girls [1]. Before diagnosis and treatment, some patients may undergo immobilization, which has been noted to increase pain levels [4]. CRPS may result in nearly immediate disability, and swift therapy referral is indicated [5]. In comparison to adults, triple-phase bone scan is a less reliable diagnostic method [1,6].
The focus of this article is to review the evidence for the type of treatment provided in our program, along with some emerging treatments that may contribute to the treatment of pediatric CRPS.
Scrambler Therapy (ST) is a new noninvasive neuro- modulation approach to the treatment of chronic neuro- pathic pain [66]. The underlying theoretical perspective does not rely on the Gate Control theory but instead on the theory that the nervous system is a cybernetic system that responds to coded information [67]. In chronic pain, nociceptors have theoretically been damaged and produce erroneous pain codes that can be produced independent of a sensory source (eg, phantom limb pain) [68]. Neuromatrix theory postu- lates that the pain signals must be reinterpreted by the brain to return to homeostasis and thereby no longer produce chronic pain [69]. ST is thought to interfere with the pain neuromatrix by providing nonpain codes [66]. Initially de- veloped as a treatment for oncological neuropathic pain and chemotherapy-induced peripheral neuropathy, ST has been used successfully on a variety of chronic pain symptoms, but there has not been a focused large-scale study of this method in the pediatric population [66]. Recent investigations of the ef?cacy of ST have all demonstrated excellent results with various forms of adult neuropathic pain (eg, neuropathy, neuralgia, CRPS, failed back syndrome) [66]. The results of ST with 173 consecutive adult admissions demonstrated signi?cant improvement across multiple diagnostic groups, including CRPS, with improvement maintained for 6 months in 75% of the patients treated [66]. Studies on ST in pediatric CRPS appear to be indicated.
