Canadian surveillance study of complex regional pain syndrome in children

Krista Baerg^{1

2}, Susan M Tupper³, Luan Manh Chu¹, Nicole Cooke⁴, Bruce D Dick^{5

6}, Marie-Joëlle Doré-Bergeron⁷, Sheri Findlay⁸, Pablo M Ingelmo⁹, Christine Lamontagne¹⁰, Giulia Mesaroli^{11

12}, Tim F Oberlander¹³, Raju Poolacherla¹⁴, Adam Oscar Spencer¹⁵, Jennifer Stinson^{16

17}, G Allen Finley¹⁸

Affiliations

¹ Department of Pediatrics, University of Saskatchewan, Saskatoon, Canada.
² Department of Pediatrics, Saskatchewan Health Authority, Saskatoon, Canada.
³ Department of Clinical Excellence, Quality, Safety & Strategy, Saskatchewan Health Authority, Saskatoon, Canada.
⁴ Patient Partner, Regina, Canada.
⁵ Departments of Anesthesiology and Pain Medicine, Psychiatry & Pediatrics, University of Alberta, Edmonton, Canada.
⁶ Faculties of Medicine and Dentistry & Rehabilitation Medicine, University of Alberta, Edmonton, Canada.
⁷ Department of Paediatrics, Faculty of Medicine, Université de Montréal, Montréal, Canada.
⁸ Department of Pediatrics, McMaster University, Hamilton, Canada.
⁹ Chronic Pain Service, Montreal Children's Hospital, McGill University Health Center, Montréal, Canada.
¹⁰ Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Canada.
¹¹ Department of Rehabilitation, The Hospital for Sick Children, Toronto, Canada.
¹² Department of Physical Therapy, University of Toronto, Toronto, Canada.
¹³ Complex Pain Service, BC Children's Hospital, Vancouver, Canada.
¹⁴ Department of Anesthesia and Perioperative Medicine and Department of Pediatrics, Children's Hospital London Health Sciences Centre, London, Canada.
¹⁵ Department of Pediatric Anesthesia, University of Calgary Cumming School of Medicine, Calgary, Canada.
¹⁶ Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada.
¹⁷ Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.
¹⁸ Departments of Anesthesia & Psychology, Dalhousie University, Halifax, Canada.

PMID: 34799536
PMCID: PMC9100430
DOI: 10.1097/j.pain.0000000000002482

Canadian surveillance study of complex regional pain syndrome in children

Krista Baerg et al. Pain. 2022.

. 2022 Jun 1;163(6):1060-1069.

doi: 10.1097/j.pain.0000000000002482. Epub 2021 Sep 13.

Authors

Affiliations

¹ Department of Pediatrics, University of Saskatchewan, Saskatoon, Canada.
² Department of Pediatrics, Saskatchewan Health Authority, Saskatoon, Canada.
³ Department of Clinical Excellence, Quality, Safety & Strategy, Saskatchewan Health Authority, Saskatoon, Canada.
⁴ Patient Partner, Regina, Canada.
⁵ Departments of Anesthesiology and Pain Medicine, Psychiatry & Pediatrics, University of Alberta, Edmonton, Canada.
⁶ Faculties of Medicine and Dentistry & Rehabilitation Medicine, University of Alberta, Edmonton, Canada.
⁷ Department of Paediatrics, Faculty of Medicine, Université de Montréal, Montréal, Canada.
⁸ Department of Pediatrics, McMaster University, Hamilton, Canada.
⁹ Chronic Pain Service, Montreal Children's Hospital, McGill University Health Center, Montréal, Canada.
¹⁰ Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Canada.
¹¹ Department of Rehabilitation, The Hospital for Sick Children, Toronto, Canada.
¹² Department of Physical Therapy, University of Toronto, Toronto, Canada.
¹³ Complex Pain Service, BC Children's Hospital, Vancouver, Canada.
¹⁴ Department of Anesthesia and Perioperative Medicine and Department of Pediatrics, Children's Hospital London Health Sciences Centre, London, Canada.
¹⁵ Department of Pediatric Anesthesia, University of Calgary Cumming School of Medicine, Calgary, Canada.
¹⁶ Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada.
¹⁷ Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.
¹⁸ Departments of Anesthesia & Psychology, Dalhousie University, Halifax, Canada.

PMID: 34799536
PMCID: PMC9100430
DOI: 10.1097/j.pain.0000000000002482

Abstract

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 reported new cases of CRPS aged 2 to 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 the Canadian Paediatric Surveillance Program, and 168 (84.8%) met the case definition. The minimum Canadian incidence of CRPS is estimated at 1.14/100,000 (95% confidence interval 0.93-1.35/100,000) children per year. Incidence was highest among girls 12 years and older (3.10, 95% confidence interval 2.76-3.44/100,000). The mean age of CRPS diagnosis was 12.2 years (SD = 2.4), with the mean time from symptom onset to diagnosis of 5.6 months (SD = 9.9) and no known inciting event for 19.6% of cases. Most 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 because of 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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Conflict of interest statement

K. Baerg reports royalties from Brush Education and serves on the Board of Directors, Saskatchewan Pain Society Inc., outside the submitted work. S. M. Tupper serves as the Chair, Board of Directors, Saskatchewan Pain Society Inc., outside the submitted work. L. M. Chu reports he is a paid employee in the Department of Pediatrics, related to the submitted work. N. Cooke has nothing to disclose. B. D. Dick has nothing to disclose. M.-J. Doré-Bergeron has nothing to disclose. S. Findlay serves as Co-Chair, Ontario Chronic Pain Network, outside the submitted work. P. M. Ingelmo has nothing to disclose. C. Lamontagne has nothing to disclose. G. Mesaroli reports funding from RESTRACOMP Clinician Scientist Training Program and Frederick Banting and Charles Best Canada Graduate Scholarship (CGS-M) from the Canadian Institutes of Health Research (CIHR), outside the submitted work. T. F. Oberlander has nothing to disclose. R. Poolacherla has nothing to disclose. A. O. Spencer has nothing to disclose. J. Stinson has nothing to disclose. G. A. Finley serves on the Executive Board, Canadian Pain Society, outside the submitted work.

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References

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Canadian surveillance study of complex regional pain syndrome in children

Affiliations

Canadian surveillance study of complex regional pain syndrome in children

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous