• Manuel J Rodriguez, Mariano Fernandez-Baena, Alex Barroso, and Jose A Yanez.
• Pain Treatment Unit. Hospital Regional Universitario "Carlos Haya" de Malaga, Spain.
• Pain Physician. 2015 Nov 1; 18 (6): 621-30.

BackgroundComplex regional pain syndrome (CRPS) is a multifactorial condition with complex pathogenesis characterized by spontaneous or stimulus-induced pain that is disproportionate to the inciting event. It is also commonly accompanied by a myriad of autonomic and motor disturbances in highly variable combinations. This condition has been underreported in children until recently. Consequently, the management of CRPS in the pediatric population presents an even greater challenge than in adults, partly because there is a lack of clinical data concerning the efficacy of the diverse treatment methods available, and partly because successful treatment of CRPS involves a multidisciplinary approach. There is a variety of invasive methods to the treatment of CRPS, but scarce pediatric-focused trials have been published to date.ObjectiveTo examine and analyze the data currently existing for the invasive management of CRPS in children. It further suggests a management algorithm based in the evidence reviewed and our team experience.Study DesignA comprehensive review of invasive management for pediatric CRPS.SettingAcademic hospital in Spain.MethodsA comprehensive review of all the evidence published to date was conducted. Four databases (PubMed, Medline, Web of Science, Embase, and Cochrane databases) were searched for articles published from 1980 to 2014. The eligibility criteria were any paper published in English or Spanish where a non-conventional approach was used to manage pediatric CRPS. Two independent reviewers extracted the data.ResultsMany case series have reported the use of interventional management with positive results; however, there is not a single randomized control trial to date comparing the conservative and the invasive management in children. The largest series of pediatric cases showed that between 29% to 35% of children with CRPS needed interventional measures to manage this condition successfully. Sympathetic blocks and spinal drug infusion emerge as the most reported techniques; the spinal infusion of drugs together with the spinal cord stimulation being the most successfully employed. Based upon the available evidence with regard to effect and complications, we recommend an algorithm for the management of pediatric CRPS.LimitationsThe limitations of this study include the paucity of literature, lack of randomized trials, and lack of quality evidence.ConclusionsInvasive techniques have been used to treat CRPS over the last few decades; however, the evidence for their use is still very weak. Invasive management should be contemplated only when high-standard conservative management has failed to work.

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