To witness anybody in chronic pain for whatever reason is dreadful, but to see children, particularly young children, in that condition is particularly heartbreaking. Adults and even adolescents do at least have the advantage of a better insight into what they are going through and what the future may have in store.
And it is the future that is especially worrying for the young suffering chronic pain. CRPS is a very good example. Some research suggests that children generally respond better than adults to multidisciplinary treatment. However, a number of long term studies following the same children show not only a high probability of a recurrence of their CRPS, but also that they are at a high risk of developing other forms of chronic pain.
In terms of children in remission from CRPS, one study demonstrated that 31% of child patients suffered a recurrence of CRPS over an average (median) period of 5 years from the completion of treatment. More startling, however, was that among those who suffered a recurrence, the average (median) time to recurrence was only 2 months with almost 80% of recurrences occurring during the first 6 months following the completion of treatment.
In another article, I considered the chances of recurrence in adults whose CRPS was in remission. Certainly, the chance of recurrence in children seems substantially higher.
Problems in treating children
Treating children with CRPS presents its own particular problems and risks.
In terms of drugs, doctors are understandably more cautious in exposing a still developing body and nervous system to the usual cocktail of opioids and antispasmodics. Further, encouraging young children in pain to actively engage in physical and psychological therapy presents its very own challenges.
Children and Vitamin C
In a recent article I considered the evidence as to whether taking Vitamin C, specifically following limb fractures or limb surgery might actually prevent the development of CRPS. Although the evidence on its efficacy is inconclusive, there is a significant body of opinion that as Vitamin C is both inexpensive and has limited side effects, taking an optimum dose daily for at least 50 days in this scenario is a worthwhile measure.
Many parents give their children a daily supplement of Vitamin C in any event with the intention of boosting their immune system. In the UK the Department of Health actually recommends that all children aged 6 months to 5 years are given supplements of certain vitamins, including Vitamin C.
With its possible additional benefit as a preventative for CRPS, and given the poor outlook for children who develop the condition, is there not a lot to be said for revisiting that advice? Perhaps both the daily dose and the upper limit of that age range should be reviewed. Certainly, as with so many aspects of CRPS in the young, further research is a priority.
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