Groundbreaking Treatment for Pain Management

In response to numerous subscriber requests, information about several Cleveland Clinic Pain Management programs is included herein.  Consistent with the treatment of other complex diseases, treating patients for chronic pain requires a comprehensive and multidisciplinary approach. 

The following article highlights information on the Pediatric Pain Rehabilitation Program.  Cleveland Clinic’s Pain Program is one of the few in the nation that treats children and teens with complex regional
pain syndrome.

Multi-disciplinary Treatments for Children with Complex
Regional Pain Syndrome, CRPS

Marah Miller was lucky to have survived a horrific head-on car accident. In addition to a few bruises, she sprained her ankle.  But the sprained ankle never healed.  It swelled and turned purple.  To make matters worse, the burning, stabbing pain intensified to the point where she could only walk with crutches.  Even when her ankle was ever so lightly touched, the pain was agonizing.

“Marah was taking a bath when a bubble touched her ankle and it was as if she was being stabbed by a butcher’s knife,” recalls Marah’s father, Murray.  “That’s how much pain she was in.”

Because of the unrelenting pain, the 13-year-old Florida girl missed school.  She stopped competing in swim meets, and she couldn’t even visit her friends without her parents’ supervision.  Though family members and friends were always loving and supportive of Marah, they grew frustrated and concerned about her worsening condition despite months of various treatments by nine different physicians.

Marah suffers from a classic case of complex regional pain syndrome (CRPS), formerly known as reflex sympathetic dystrophy syndrome (RSDS), a painful nerve disorder usually triggered after an injury, says Michael Stanton-Hicks, MD, Department of Pain Management at Cleveland Clinic.  Dr. Stanton-Hicks is one of the world’s leading CRPS authorities.

“The injury usually occurs in the arms or legs and the pain does not go away, gets worse and can spread to other parts of the body,” says Dr. Stanton-Hicks.

What causes this condition is a mystery.  Scientists are now working on a number of mechanisms that involve abnormal nerve inflammation in the affected region and changes in the central nervous system. These, and other causes are responsible for the features that are seen such as skin color, texture, swelling, loss of normal movement, weakness and alterations in the underlying structure such as joints, tendons and ligaments.

Up to 7 percent of children develop CRPS after an injury, and about 8 to 10 percent of injured adults get the condition following an injury.  But because it is not widely known or understood, CRPS is often misdiagnosed, and many patients undergo erroneous or excessive treatments, says Dr. Stanton-Hicks.

A pain management physician referred the Millers to Dr. Stanton-Hicks, who led a panel of medical professionals that developed and launched Cleveland Clinic’s Pediatric Pain Rehabilitation Program.

“Because CRPS is so complex and because it impacts the patients’ lives and their families in so many different ways, we developed this program to provide comprehensive treatments across several medical disciplines,” says Dr. Stanton- Hicks.  “It is one of the few programs in the nation that offer an interdisciplinary approach to pain management for children and teens. About 90 percent of patients treated in our program experience remission of their pain, and about 15 percent of those patients
have relapses.”

After undergoing a thorough evaluation, the children are treated by a team of physicians, psychiatrists, psychologists, physical, occupational and recreational therapists, nurses, dieticians and social
service professionals.

“Physical therapies seem to be the key for both adults and children, but with children their response to physical therapy is very good in part because of their developmental nature,” says Dr. Stanton-Hicks.  “Psychological counseling also seems to work very well for children perhaps because they don’t have the preconceived inhibitions and attitudes that adults do.”

While most children still need medication to help them manage their pain, opiates are used minimally.  Instead, corticosteroids, antidepressants, anti-seizures medications, as well as topical analgesics have been shown to effectively treat most CRPS patients.  Other treatments may include sympathetic nerve blocks, intrathecal drug pumps and spinal cord stimulation.  These treatments, however, are temporary and usually apply to a small percentage of patients.

Parents also participate in counseling, and children are required to continue their education during the two to three weeks of inpatient and outpatient treatments.

“My daughter went into the program with crutches, and she walked out of the program on her own two legs,” says Murray.  “It was a very emotional moment for me and my daughter.  We’ll never forget it.”