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Arthritis und Rheuma 2013; 33(06): 393-400
DOI: 10.1055/s-0037-1618203
Alltägliches in der kinderrheumatologischen Praxis?
Schattauer GmbH

Das komplexe regionale Schmerzsyndrom bei Kindern und Jugend lichen

Klinisches Bild, diagnostische Kriterien und therapeutische OptionenComplex-regional pain syndrome in childhood and adolescenceClinical signs and symptoms, diagnostic procedures and therapy approaches
K. Gerhold
1   Klinik für Pädiatrie mit Schwerpunkt Pneumologie und Immunologie, Charité – Universitätsmedizin Berlin
2   Deutsches Rheumaforschungszentrum, ein Institut der Leibniz-Gemeinschaft, Berlin
› Institutsangaben
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Publikationsverlauf

Publikationsdatum:
27. Dezember 2017 (online)

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Zusammenfassung

Das komplexe regionale Schmerzsyndrom (CRPS) ist bei Kindern und Jugendlichen eine seltene Erkrankung, die durch regional begrenzte Schmerzen stärksten Ausmaßes charakterisiert ist und von sensorischen, motorischen und autonomen Funktionsstörungen in variabler Ausprägung begleitet wird. Als Auslöser gelten Gewebeverletzungen aller Art, deren Schweregrad nicht mit der Symptomatik des CRPS korreliert. Die Diagnose wird nach Ausschluss anderer, die Symptome erklärender Erkrankungen anhand rein klinischer Kriterien gestellt. Apparative und laborchemische Untersuchungen sind dagegen nur wenig spezifisch. Aufgrund häufig vorhandener schwerer psychischer Probleme und/ oder einschneidender Lebensereignisse vor Krankheitsmanifestation sollte eine psychologische Diagnostik frühzeitig stattfinden. Empfohlen wird eine multimodale Therapie unter besonderer Berücksichtigung physiotherapeutischer Verfahren; die Wirksamkeit medikamentöser oder invasiver Therapien ist für das Kindesalter nicht belegt. Die Prognose ist unklar. Um Remissionen erreichen und Rezidive am ehesten verhindern zu können, erscheinen ein frühzeitiger Therapiebeginn und eine unterstützende psychologische Betreuung erforderlich.

Summary

The complex regional pain syndrome (CRPS) is a rare disease entity in children and adolescents characterized by severe regional pain accompanied by symptoms due to sensory, motoric and autonomic dysfunction of a variable extent. Trigger factors may be any kind of tissue damage; however, as a rule, symptoms are out of proportion to the degree of injury. After exclusion of other possibly underlying diseases, diagnostic criteria are based on patient-reported symptoms and physician-assessed clinical signs; further tests including imaging are usually unspecific. Many children suffer from serious psychological problems or experienced critical life events prior to disease manifestation. Therefore, psychological diagnostics should be implemented early in the disease course. Therapy is supposed to be multidisciplinary with a specific focus on physiotherapy; any drug therapy or invasive treatment approaches have not been shown to be effective for CRPS in this age group and cannot be generally recommended. Prognosis seems to benefit from early treatment start and from accompanying psychotherapy; then remission can be achieved and recurrence of this probably disabling disease can be avoided.

Schlüsselwörter

Komplexes regionales Schmerzsyndrom - Reflexdystrophie - Kinder und Jugendliche - multimodale Therapie

Keywords

Complex Regional Pain Syndrome - reflex sympathethic dystrophy - children and adolescents - multimodal therapy
 

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