Characterisation and non-pharmacological treatment of Complex Regional Pain Syndrome in under-18-year-olds: a scoping review.

UNLABELLED: The aim of this review was to explore the published literature describing the presentation, characteristics, and non-pharmacological treatments of Complex Regional Pain Syndrome (CRPS) in under 18-year-olds. This scoping review was conducted in line with the Preferred Reporting Guidelines for Scoping Reviews (PRISMA-ScR). Five online databases (AMED, CINAHL + , EMBASE, EBSCO, and MEDLINE) were systematically searched with identified key terms for relevant records and screened against the eligibility criteria. Extracted data from the included studies informed a narrative synthesis. The PAGER framework was used to succinctly present gaps in the field and recommend future directions for research. Online searches yielded 140 articles. Following screening, 30 articles were included for review. Findings suggest primary symptoms included extreme pain, allodynia, and nail changes. The Budapest criteria, radiography, bone scans and laboratory examinations were commonly used diagnostic methods. Various non-pharmacological interventions were used, such as physiotherapy (home exercise), hydrotherapy, desensitisation, and cognitive behavioural therapy.

CONCLUSION: The most common symptom in children is severe pain that is disproportionate to the inciting event. Critical gaps in the evidence base such as the absence of age appropriate, validated diagnostic criteria, lack of research understanding the lived experience and impact of the condition or exploring treatment efficacy, were identified as knowledge gaps within the field.

WHAT IS KNOWN: • Complex Regional Pain Syndrome is a difficult to diagnose and hard to treat pain condition. Among children, it is not well documented or understood, there are no agreed diagnostic criteria or treatment guidelines.

WHAT IS NEW: • This scoping review summarises and presents the published research regarding presentation, diagnosis and non-pharmacological treatment of paediatric CRPS. • Issues relating to the use of treatments lacking demonstrable efficacy and the need for quick and reliable diagnoses are discussed. • Using the PAGER Framework, this review exposes critical gaps in both research (the lack of research around condition experience and treatment efficacy) and practice (the lack of validated diagnostic criteria and treatment pathways) outlining clear and urgent recommendations.