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BACKGROUND Pain is common among children, with an estimated prevalence ranging from 20% to 46% globally. Musculoskeletal pain accounts for 4% to 40% of these cases, while back pain represents approximately 14% to 24% (1,2). This rise in prevalence has been associated with increased traumatic events, cancer-related pain, chronic illnesses, autoimmune diseases, and maladaptive and poorly controlled injuries that children present in the early years (1,3). Treating chronic pain can be particularly challenging in the pediatric population, due to the emotional, physical, and economic implications for children and their families (4). Self-reported pain may be misinterpreted and difficult to categorize, particularly among younger children. It is crucial to conduct a comprehensive evaluation that includes a global assessment of pain intensity as well as physical and emotional functioning (4). Recommended treatment for pediatric chronic pain includes analgesics such as NSAIDs, physical therapy, and opioids in refractory cases. The limited number of pharmacologic therapies approved by the Food and Drug Administration (FDA) for this patient population creates an opportunity for exploring new interventions, particularly in the treatment of musculoskeletal and neuropathic pain (4). Interventional pain treatments such as lumbar sympathetic block are well described for the treatment of Complex regional pain syndrome (CRPS) in adults but are less well described in the pediatric population. CRPS is a spectrum of numerous clinical presentations ranging from disproportionate chronic pain, vasomotor dysfunction, swelling, and allodynia (5). CRPS can be classified into two main types: CRPS-I, which is the most common in children and where the nerve lesion is not well identified, and CRPS-II, where a specific nerve lesion can be identified (5). CRPS can be associated with prior trauma to a specific body part. However, it can potentially develop with a minor or even without any prior lesion (6,7). The incidence ranges from 5.46 to 26.2 per 100,000 person-years (8). Among children and adolescents, a higher incidence is observed between the ages of 5 to 17, with a peak occurrence at 13 years old (9). Lumbar sympathetic block has been indicated for treating sympathetic-mediated pain in adults with CRPS, it is considered a common practice in the management and control of pain. This procedure aims to reduce the overactivity of the sympathetic nervous system, decreasing pain and allowing the patient to rest (10). In contrast, limited research has been conducted on its use in children. Our objective is to conduct a systematic review to guide our understanding and evaluation of the benefits of lumbar sympathetic block for the treatment of CRPS in the pediatric population, guide future research efforts, and determine the optimal approach for evaluating pain control in children after the procedure. This review will assist researchers in identifying areas that require further investigation and provide a comprehensive overview of the current state of knowledge in this area. |
