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| GENDER DIFFERENCES IN CRPS1/ RSD IN CHILDREN AND ADOLESCENTS Charles Berde, M.D., Ph.D., Harvard Medical School, Director, Pain Treatment Service, Boston Children's Hospital, Boston, Massachusetts Complex regional pain syndrome, type 1 (CRPS1) or reflex sympathetic dystrophy (RSD) is being diagnosed more frequently in children and adolescents. Over the last 12 years, our pain center has examined the demographics, associated medical and lifestyle factors, and responses to treatment in over 450 patients. Some demographic features in children appear different from those described for adults: (1) Children and adolescents have lower extremity involvement 6 times more often than upper extremity involvement. (2) Girls are affected roughly 5 times as often as boys. (3) RSD/CRPS1 is rare below age 8; the incidence increases markedly just before puberty. (4) Female dancers, gymnasts and competitive athletes comprise a high percentage of the patients. A high percentage of patients present either confined to crutches or in a wheelchair. School absenteeism is more common in these patients than in a matched population of rheumatology patients. Coexisting psychiatric diagnoses commonly include depression, anxiety disorders, post-traumatic stress disorders, distorted body image and eating disorders, and stressful family dynamics. Treatments advocated for RSD have varied largely according to subspecialty and training of health providers. A program for prospective evaluation of these patients was established recently with funding from NICHD. Preliminary studies by Dr. Sethna and others on quantitative sensory and autonomic evaluation will be summarized. Treatments under prospective controlled evaluation include physical therapy, cognitive-behavioral interventions, tricyclics and anticonvulsants, and continuous-infusion sympathetic blocks. Preliminary data from these trials and a long-term followup study will be summarized, and future research questions will be addressed.
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