Dataset Information

Rapid treatment-induced brain changes in pediatric CRPS.

ABSTRACT: To date, brain structure and function changes in children with complex regional pain syndrome (CRPS) as a result of disease and treatment remain unknown. Here, we investigated (a) gray matter (GM) differences between patients with CRPS and healthy controls and (b) GM and functional connectivity (FC) changes in patients following intensive interdisciplinary psychophysical pain treatment. Twenty-three patients (13 females, 9 males; average age ± SD = 13.3 ± 2.5 years) and 21 healthy sex- and age-matched controls underwent magnetic resonance imaging. Compared to controls, patients had reduced GM in the primary motor cortex, premotor cortex, supplementary motor area, midcingulate cortex, orbitofrontal cortex, dorsolateral prefrontal cortex (dlPFC), posterior cingulate cortex, precuneus, basal ganglia, thalamus, and hippocampus. Following treatment, patients had increased GM in the dlPFC, thalamus, basal ganglia, amygdala, and hippocampus, and enhanced FC between the dlPFC and the periaqueductal gray, two regions involved in descending pain modulation. Accordingly, our results provide novel evidence for GM abnormalities in sensory, motor, emotional, cognitive, and pain modulatory regions in children with CRPS. Furthermore, this is the first study to demonstrate rapid treatment-induced GM and FC changes in areas implicated in sensation, emotion, cognition, and pain modulation.

SUBMITTER: Erpelding N

PROVIDER: S-EPMC4470894 | biostudies-literature | 2016 Mar

REPOSITORIES: biostudies-literature

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Rapid treatment-induced brain changes in pediatric CRPS.

Erpelding Nathalie N Simons Laura L Lebel Alyssa A Serrano Paul P Pielech Melissa M Prabhu Sanjay S Becerra Lino L Borsook David D

Brain structure & function 20141217 2

To date, brain structure and function changes in children with complex regional pain syndrome (CRPS) as a result of disease and treatment remain unknown. Here, we investigated (a) gray matter (GM) differences between patients with CRPS and healthy controls and (b) GM and functional connectivity (FC) changes in patients following intensive interdisciplinary psychophysical pain treatment. Twenty-three patients (13 females, 9 males; average age ± SD = 13.3 ± 2.5 years) and 21 healthy sex- and age-m ...[more]

PMID: 25515312

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Project description:BackgroundComplex Regional Pain Syndrome (CRPS) is a condition that causes persistent and debilitating pain. It is often associated with physical injury but can also occur without identifiable trauma or ongoing injury. There are no published guidelines for CRPS treatment in the pediatric population, but interdisciplinary care, medication, and physical therapy are common approaches. Sometimes, interventional procedures such as regional anesthesia may be required to manage symptoms.ObjectiveThe objective of this literature review is to explore the different interventional pain management approaches that are currently being used and have shown effectiveness in the management of CRPS in the pediatric population.MethodsWe conducted a comprehensive search strategy with an experienced librarian and input from the study's principal investigator from January 1st, 2000 to April 2nd, 2024. The search was conducted in multiple databases using controlled vocabulary and keywords to identify studies relevant to invasive treatments for pediatric CRPS.ResultsOf 825 studies screened, 27 met inclusion criteria, predominantly case reports (70%). The analysis included 183 patients aged 7-18 years, with female predominance (81.4%). Lower extremities were most commonly affected (70.49%), and most cases (83.06%) were triggered by identifiable trauma. IASP and Budapest criteria, though not validated for pediatric populations, were inconsistently utilized across studies for CRPS diagnosis. Interventional procedures were typically implemented after failed conservative management (92.89%), which included multiple medications (e.g., pregabalin, amitriptyline, NSAIDs) combined with physical and psychological therapy. Multiple interventional procedures were often required to achieve pain relief or functional improvement. Follow-up periods were not reported in most studies and, when reported, were short, limiting the assessment of long-term intervention efficacy.ConclusionsThis review summarizes the different interventional pain management methods utilized to treat pediatric CRPS. While techniques such as continuous epidural anesthesia, lumbar sympathetic blocks, peripheral procedures, and spinal cord stimulation have been safely and successfully used as part of a multimodal treatment strategy, the lack of high-quality evidence and specific protocols for CRPS diagnosis and management in pediatric patients calls for further research.

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Rapid treatment-induced brain changes in pediatric CRPS.

Publications

Rapid treatment-induced brain changes in pediatric CRPS.

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