小児CRPS(複合性局所疼痛症候群)の特徴
CRPSは、症状の集まりを特徴とする四肢の痛みを伴う状態です。小児CRPSの臨床的な特徴はほとんど知られておらず, 今日まで1ダース以下の研究しかない。この研究の目的は、臨床的特徴と疾患転帰に重点を置いて、小児 CRPSの臨床経過を探ることでした。副次的な目的は、関連する運動障害の有無にかかわらず、小児 CRPSの臨床的特徴の違い、および好ましい転帰と好ましくない転帰を示した子どもたちの違いを識別することでした。方法:5年間(2012-2016)にカナダの小児慢性疼痛クリニックに来院したCRPSの小児の後ろ向きのカルテのレビュー。結果:この研究では、CRPSの子ども59人を特定しました(平均年齢12.7±2.5、女性74.6%、下肢72.9%)。子どもの87%(n = 48)がCRPSの完全な消散または有意な改善を経験し、再発率は15%でした。25%(n = 15)には、CRPS関連の運動障害がありました。関連する運動障害の有無にかかわらず、小児 CRPSの臨床的 特徴に違いはありませんでした。良好な転帰を経験した子供は、不利な転帰を経験した子供と比較して、初回来院時の症状持続時間が有意に短かった。討論:このコホートでは、小児 CRPSは12歳前後の女性で最も一般的であり、通常は下肢であり、ほとんどが良好な結果を経験しました。小児 CRPSの予後と再発率をよりよく理解するには、さらなる研究が必要です。
Clin J Pain. 2019 Sep 4. doi:10.1097/AJP.0000000000000759. [Epub ahead of print]
Clinical Features of Pediatric Complex Regional Pain Syndrome: A 5-Year RetrospectiveChart Review.
Mesaroli G1,2, Ruskin D3, Campbell F4, Kronenberg S5,6, Klein S1, Hundert A7, Stinson J7,8.
1
Departmentof Rehabilitation, The Hospital for Sick Children.
2
Departmentof Physical Therapy, University of Toronto.
3
Departmentof Psychology, The Hospital for Sick Children.
4
Departmentof Anesthesia and Pain Medicine, The Hospital forSick Children, University of Toronto.
5
Departmentof Psychiatry, The Hospital for Sick Children.
6
Departmentof Psychiatry, University of Toronto.
7
Child HealthEvaluative Sciences, Research Institute, The Hospital for Sick Children.
8
Lawrence S.Bloomberg Faculty of Nursing, at the University of Toronto, Toronto, Canada.
Abstract
OBJECTIVES:
Complexregional pain syndrome (CRPS) is apainful condition of a limb characterized by a constellation of symptoms.Little is known about the clinical features of pediatric CRPS,with fewer than a dozen studies published to date. The aim of this study was toexplore the clinical course of pediatric CRPS,with emphasis on clinical features and disease outcomes. A secondary aim was todiscern differences in clinical features of pediatric CRPSwith and without related movement disorders, and between children who had afavorable and unfavorable outcome.
METHODS:
Retrospective chartreview of children with CRPS who presented to apediatric Chronic Pain Clinic in Canada over a5-year period (2012-2016).
RESULTS:
The study identified 59children with CRPS (mean age 12.7±2.5; 74.6%female; 72.9% lower extremity). Eighty-seven percent (n=48) of childrenexperienced completely resolution or significantly improvement of CRPS, with a relapse rate of 15%. Twenty-five percent(n=15) had a CRPS-related movement disorder. Therewere no differences in the clinical features of pediatric CRPS with or without related movement disorders.Children who experienced a favorable outcome had a significantly shorter symptomduration at initial visit in comparison to children who experienced anunfavorable outcome.
DISCUSSION:
In this cohort, pediatric CRPS was most common in females around the age of 12,usually in the lower extremity, and most experienced a favorable outcome.