Invasive treatments for pediatric Complex Regional Pain Syndrome -- A scoping review

This review aimed to synthesize the current evidence on the effectiveness of invasive treatments for CRPS in children and adolescents. Studies on children and adolescents with CRPS that evaluated the effects of invasive treatment were identified in PubMed (search March 2013). Thirty-six studies met the inclusion criteria. Articles reported on a total of 173 children and adolescents with CRPS. Generally, many studies lack methodological quality. The invasive treatments applied most often were singular sympathetic blocks, followed by epidural catheters and continuous sympathetic blocks. Rarely, spinal cord stimulation and pain directed surgeries were reported. An individual patient frequently received more than one invasive procedure. Concerning outcome, for nearly all patients an improvement in pain and functional disability was reported. However, these outcomes were seldom assessed with validated tools. In conclusion, the evidence level for invasive therapies in the treatment of CRPS in children and adolescents is weak.