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The Good, Bad, and the Ugly: Treatment of Complex Regional Pain The Good, Bad, and the Ugly: Treatment of Complex Regional Pain The Good, Bad, and the Ugly: Treatment of Complex Regional Pain The Good, Bad, and the Ugly: Treatment of Complex Regional Pain Syndrome (CRPS) in Syndrome (CRPS) in Syndrome (CRPS) in Syndrome (CRPS) in PediatricsPediatricsPediatricsPediatrics

By Heidi Kempert, PTA

kemperh@ccf.orgCleveland Clinic Children’s Hospital for Rehabilitation

Pediatric Pain Rehab Program

Centralized Pain

Reflex neurovascular dystrophy (RND)

Reflex Sympathetic Dystrophy Syndrome (RSD)

Central and Peripheral Nervous System

High Level of Nerve Impulses and Pain Signals

Immune and Autonomic Responses

Specific Areas of Treatment for CRPS

• Desensitization

• Swelling management

• Range of motion

• Weight bearing

• Gait training

• Functional mobility

• Strength and endurance

• Symmetry and body awareness

• Balance and neuromuscular re-education

• Guarding/Habitual movement education

• Patient and family education

• Patient goals and motivations!

• Be creative and fun!

Quick diagnosis and initiation of therapies is important after ruling out

acute injury and obtaining appropriate medical clearance

A Spectrum…

Tolerance, Reactions, Progression

Using A Multidisciplinary Approach: Finding a Balance

Stress

Pain

Alignment

Weight Bearing

Breathing

Anxiety

Feeling Unstable

Expectations

• Imagery

• Acupressure

• Deep Breathing/Belly Breathing

• Distraction

• Progressive Muscle Relaxation

• Positive Mental Attitude

• Problem Solving

Introduce Coping

Strategies

Less

Support/Fear

of Falling

Participation

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Return to LifeReturn to LifeReturn to LifeReturn to Life

Return to School

- Modified Mobility

- Movement/Pace breaks

- Modified Gym Class or Recess

* Talk with Schools!

Return to Sports/Leisure

- Gradual progression

- Prevents acute injury or flare

- Only change one “area” of challenge

- Practice

- Sports

- Intensity

- Total Time

*Talk with Coaches!

Walking/Night Splint

Discharge

Day

Case Studies

Discharge Day

Supported

PositioningAquatics

Pre-gait

CRPS OutcomesData collected between 2015-2016, N=40

Means (SD) on objective (physical activity) measures at admission and discharge.

Admission Mean (SD) Discharge Mean(SD) Paired t-test

Kneeling Push-Ups 18.0 (13.79) 28.25 (14.36) -5.620***

Elbow Planks 22.19 (17.15) 47.1 (17.39) -8.696***

Step-Ups 11.1 (11.17) 30.56 (18.26) -6.328***

Jump Rope 2.86 (7.18) 33.6 (30.55) -5.965***

Squat Box Lifts 7.74 (5.95) 14.63 (9.22) -3.964***

Box Carry 4.0 (4.32) 9.89 (6.24) -5.266***

Sit to Stand 7.07 (10.44) 24.25 (11.46) -7.414***

6 minute walk 565.5 (763.9) 1553.06 (690.07) -4.813***

Means (SD) on self-report measures at admission and discharge.

Range Admission Mean (SD) Discharge Mean (SD) Paired t-test

LEFS 0 – 80 33.08 (16.48) 50.65 (19.45) 8.066***

UEFI 0 – 80 48.55 (18.08) 62.95 (14.28) 8.039***

Pain 0 – 10 7.35 7.68 .888

**p<.01

***p<.001

It is typical for pain to not

decrease quickly- this matches

chronic pain treatment

philosophy!

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