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Complex regional pain syndrome following immunisation
  1. Stephanie Richards1,
  2. George Chalkiadis2,
  3. Raman Lakshman3,
  4. Jim P Buttery1,4,5,
  5. Nigel W Crawford1,4,6
  1. 1SAEFVIC, Department of General Medicine, Royal Children's Hospital (RCH), Melbourne, Victoria, Australia
  2. 2Department of Anaesthetics and Pain Management, Royal Children's Hospital, Melbourne, Victoria, Australia
  3. 3Department of Paediatrics, West Suffolk Hospital NHS Trust, Suffolk, UK
  4. 4Murdoch Children's Research Institute (MCRI), Melbourne, Victoria, Australia
  5. 5Paediatric Infectious Diseases Unit, Department of Paediatrics, Monash Children's Hospital, Southern Health, Monash University, Melbourne, Victoria, Australia
  6. 6Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
  1. Correspondence to Dr Nigel W Crawford, SAEFVIC Immunisation Safety Service, Department of General Medicine, Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Road, Parkville, Melbourne, VIC 3052, Australia; nigel.crawford{at}


Complex regional pain syndrome type 1 (CRPS-1) is a clinical syndrome that affects one or more extremities and is characterised by persistent pain disproportionate to any inciting event, and at least one sign of autonomic dysfunction in the affected limb(s). The pathogenesis of this syndrome is poorly understood, but its onset is often precipitated by a physical injury, such as minor trauma, fracture, infection or a surgical procedure. In the literature, there are reports of CRPS-1 following immunisation with rubella and hepatitis B vaccines. Here we present a case series of CRPS-1 following immunisation in adolescents, with either diphtheria-tetanus-acellular pertussis (1 case), or human papillomavirus vaccines (4 cases). Enhanced awareness of this syndrome and its potential to occur following immunisation in the paediatric population is vital to the prompt and effective management of this condition.

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