A new study indicates that children with Complex Regional Pain Syndrome (CRPS) formerly known as Reflex Sympathetic Dystrophy (RSD) aka Reflex Neurovascular Dystrophy (RND) have a lower incidence of  Anxiety and Depression symptoms when compared to children with chronic primary headaches and functional abdominal pain.

Psychological distress and stressful life events in pediatric complex regional pain syndrome

Julia Wager Ms Psychol1,2, Hannah Brehmer MD2, Gerrit Hirschfeld Ms Psychol3, Boris Zernikow MD1,2

Pain Research & Management : The Journal of the Canadian Pain Society20.4(Jul/Aug 2015): 189-194.

Complex regional pain syndrome (CRPS) is increasingly recognized as a serious pain disorder in children and adolescents. CRPS is associated with strong physical impairments and appears to have unfavourable long-term outcomes in many affected children and adolescents (1,2).

Treating CRPS is challenging because there is little knowledge on the etiology and pathophysiology of this disorder. Several different pathophysiological factors of CRPS have been proposed, and include inflammatory processes, autoimmune responses, abnormal cytokine production, sympathetic-sensory disorders or functional changes in the central nervous system (3). Additionally, psychological distress, such as anxiety or depression, and psychosocial factors, such as stressful life events, are potential etiological factors for CRPS (3,4).

In the present study, we focus on the role of psychological distress and the experience of stressful life events in CRPS. It is indisputable that CRPS is associated with psychological distress, such as symptoms of depression or anxiety, and impairment in psychosocial functioning such as decreased quality of life and role functioning (3,5-8). However, it is difficult to determine the extent to which impairment of emotional and psychosocial functioning is a result of ongoing pain and disability in children with CRPS, or whether these factors contribute to the development or maintenance of CRPS.

Evidence from prospective studies in adults indicates that psychological distress does not cause CRPS (3,7,9). As such, no prospective studies have investigated the association between psychological distress and CRPS in children. It may not be appropriate to apply findings from adult research to the etiology of CRPS in children, because CRPS in children presents differently than CRPS in adults (1,10). Therefore, there may also be differences in the etiology of the disorder.

Background:

There is little knowledge regarding the association between psychological factors and complex regional pain syndrome (CRPS) in children. Specifically, it is not known which factors precipitate CRPS and which result from the ongoing painful disease.

Objectives:

To examine symptoms of depression and anxiety as well as the experience of stressful life events in children with CRPS compared with children with chronic primary headaches and functional abdominal pain. Methods: A retrospective chart study examined children with CRPS (n=37) who received intensive inpatient pain treatment between 2004 and 2010. They were compared with two control groups (chronic primary headaches and functional abdominal pain; each n=37), who also received intensive inpatient pain treatment. Control groups were matched with the CRPS group with regard to admission date, age and sex. Groups were compared on symptoms of depression and anxiety as well as stressful life events.

Results:

Children with CRPS reported lower anxiety and depression scores compared with children with abdominal pain. A higher number of stressful life events before and after the onset of the pain condition was observed for children with CRPS.

Conclusions:

Children with CRPS are not particularly prone to symptoms of anxiety or depression. Importantly, children with CRPS experienced more stressful life events than children with chronic headaches or abdominal pain. Prospective long-term studies are needed to further explore the potential role of stressful life events in the etiology of CRPS.

1German Paediatric Pain Centre, Children’s and Adolescents’ Hospital Datteln, Witten/Herdecke University; 2Department of Children’s Pain Therapy and Paediatric Palliative Care, Witten/Herdecke University, Faculty of Health, School of Medicine; 3University of Applied Sciences Osnabrück, Germany

Correspondence: Dr. rer. nat. Dipl.-Psych. Julia Wager; German Paediatric Pain Centre, Children’s Hospital Datteln; Dr.-Friedrich Steiner Str. 5; 45711 Datteln, Germany. Telephone 49-2363-975-184, fax 49-2363-975-181, e-mail j.wager@deutsches-kinderschmerzzentrum.de