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Bitte nicht noch mehr verletzen!

Plädoyer gegen eine invasive Schmerztherapie bei Kindern mit komplexem regionalem Schmerzsyndrom (CRPS)

Please don’t hurt me!

A plea against invasive procedures in children and adolescents with complex regional pain syndrome (CRPS)

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Zusammenfassung

Hintergrund

Das komplexe regionale Schmerzsyndrom (CRPS; früher M. Sudeck) wird auch bei Kindern und Jugendlichen diagnostiziert. Die klinische Präsentation ist nicht immer typisch. Potenziell schädliche invasive schmerztherapeutische Maßnahmen kommen bei betroffenen Kindern zu häufig zum Einsatz.

Material und Methoden

Eine retrospektive Analyse stationär behandelter Kinder mit CRPS wurde durchgeführt.

Ergebnisse

In 6 Jahren wurden stationär 37 Kinder und Jugendliche (35 weiblich, mittleres Alter: 14,3 Jahre) multimodal konservativ schmerztherapeutisch behandelt. Bei der Nachuntersuchung von 26 Patienten (70%) zeigte sich eine signifikante Verbesserung der Erkrankung auf den Ebenen Schmerz, Beeinträchtigung und Medikamenteneinnahme. Zuvor hatte jeder Patient im Mittel 4,4 verschiedene Medikamente erhalten (Spanne: 1–10). Dabei waren 29 verschiedene Pharmaka eingesetzt worden. Invasive schmerztherapeutische Maßnahmen hatten 16 Patienten (43%) frustran durchlitten, 13 Kinder mehrfach. Am häufigsten kamen Sympathikusblockaden zum Einsatz, aber auch Operationen und regionalanästhesiologische Verfahren wurden durchgeführt.

Schlussfolgerung

Bei Kindern und Jugendlichen mit CRPS, die auf eine konservative multiprofessionelle Schmerztherapie in der Regel positiv reagieren, werden zu häufig invasive schmerztherapeutische Maßnahmen eingesetzt, ohne dass deren Nutzen belegt ist.

Die englische Volltextversion dieses Beitrags ist in SpringerLink (unter „Supplemental“) verfügbar.

Abstract

Background

Complex regional pain syndrome (CRPS; formerly known as Morbus Sudeck/reflex dystrophy) is diagnosed in children and adolescents, but the clinical presentation is often atypical. Unfortunately, potentially harmful, invasive treatments are used in pediatric patients.

Patients and methods

A retrospective chart study of pediatric chronic pain patients with CRPS was performed.

Results

Over the course of 6 years, 37 (35 girls) children and adolescents took part in a multidisciplinary chronic pain inpatient program. At admission, patients took on average 4.4 (range 1–10) different medications and 29 different pharmaceuticals were used overall. Prior to admission, invasive pain treatments were performed without success in 16 of the children (43%). At least 13 children received two or more invasive treatments. Although sympathetic blocks were most prevalent, operations and regional anesthesia were also used.

Conclusion

Despite a lack of evidence for invasive procedures, these continue to be used in children and adolescents with CRPS, who later respond positively to conventional treatment.

The English full-text version of this article is available at SpringerLink (under “Supplemental”).

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Authors and Affiliations

  1. Deutsches Kinderschmerzzentrum, Vestische Kinder- und Jugendklinik, Universität Witten/Herdecke, Dr.-Friedrich-Steiner-Str. 5, 45711, Datteln, Deutschland

    B. Zernikow, M. Dobe, G. Hirschfeld, M. Blankenburg & M. Reuther

  2. Vodafone Stiftungslehrstuhl für Kinderschmerztherapie und Pädiatrische Palliativmedizin, Universität Witten/Herdecke, Witten, Deutschland

    B. Zernikow, M. Dobe, G. Hirschfeld, M. Blankenburg & M. Reuther

  3. Abteilung für Schmerzmedizin, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH, Ruhr-Universität Bochum, Bochum, Deutschland

    C. Maier

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  1. B. Zernikow
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  2. M. Dobe
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  3. G. Hirschfeld
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  4. M. Blankenburg
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  5. M. Reuther
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  6. C. Maier
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Correspondence to B. Zernikow.

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Zernikow, B., Dobe, M., Hirschfeld, G. et al. Bitte nicht noch mehr verletzen!. Schmerz 26, 389–395 (2012). https://doi.org/10.1007/s00482-012-1164-2

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