Pediatric chronic pain is a critical national health problem resulting in high levels of healthcare utilization. The physical and psychological consequences associated with chronic pain impact overall health and can predispose the development of adult chronic pain. Examining brain-behavior relations among children with chronic pain is essential as psychosocial processes reciprocally interact with physiologic processes to influence pain outcomes. The proposed research utilizes neuroimaging (fMRI) and psychophysiological techniques to enhance our understanding of these relations. Pain-related fear, an essential construct associated with the maintenance of pain-related disability, is the psychosocial process of focus in the current research proposal. The long-term goal of this K23 award is for the candidate to establish a programmatic line of patient-oriented research to integrate behavioral and neuroimaging techniques. The intent is to understand the neural mechanisms of fear and associated negative affect associated with the maintenance of pain-related disability among youth with chronic pain;ultimately characterizing mechanisms of change and treatment responses to psychological interventions targeting children with chronic pain. Complex Regional Pain Syndrome (CRPS) was chosen as a model condition, as a high proportion of patients with CRPS experience persistent pain-related fear. The primary training objective is to acquire expertise in the use of fMRI for use in future studies. The candidate will accomplish this through: 1) mentorship in a clinical/research environment, 2) hands-on training in fMRI by the candidate's sponsor and co-sponsors complemented by didactics in fMRI and advanced statistics, and 3) execution of the proposed research plan. Study 1 assesses activation of the amygdala and related areas in association with fear of pain in a cohort of pediatric pain patients with CRPS. Study 2 examines acute and long-term changes in activation of the amygdala and related areas in a cohort of CRPS patients with high fear imaged at admission, discharge, and six months after an intensive pain rehabilitation program where previously avoided and feared activities are confronted. These studies will lay the groundwork for future neural investigations examining pediatric chronic pain and the impact of fear and associated negative affect. Public Health Relevance: Recurrent, chronic pain can affect up to a quarter of children and can persist into adulthood. Understanding the neural underpinnings of persistent pain and associated negative affect among children can inform future treatments to ameliorate their suffering, making it a critical area of empirical investigation.

Public Health Relevance

Recurrent, chronic pain can affect up to a quarter of children and can persist into adulthood. Understanding the neural underpinnings of persistent pain and associated negative affect among children can inform future treatments to ameliorate their suffering, making it a critical area of empirical investigation.

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
5K23HD067202-03
Application #
8442316
Study Section
Pediatrics Subcommittee (CHHD)
Program Officer
Haverkos, Lynne
Project Start
2011-03-01
Project End
2016-02-29
Budget Start
2013-03-01
Budget End
2014-02-28
Support Year
3
Fiscal Year
2013
Total Cost
$116,210
Indirect Cost
$8,586
Name
Children's Hospital Boston
Department
Type
DUNS #
076593722
City
Boston
State
MA
Country
United States
Zip Code
02115
Kalapurakkel, Sreeja; Carpino, Elizabeth A; Lebel, Alyssa et al. (2015) "Pain Can't Stop Me": Examining Pain Self-Efficacy and Acceptance as Resilience Processes Among Youth With Chronic Headache. J Pediatr Psychol 40:926-33
Smith, Allison M; Sieberg, Christine B; Odell, Shannon et al. (2015) Living Life With My Child's Pain: The Parent Pain Acceptance Questionnaire (PPAQ). Clin J Pain 31:633-41
Cappucci, S; Simons, L E (2015) Anxiety sensitivity and fear of pain in paediatric headache patients. Eur J Pain 19:246-52
Simons, Laura E; Pielech, Melissa; Cappucci, Stefanie et al. (2015) Fear of pain in pediatric headache. Cephalalgia 35:36-44
Pielech, Melissa; Ryan, Maggie; Logan, Deirdre et al. (2014) Pain catastrophizing in children with chronic pain and their parents: proposed clinical reference points and reexamination of the Pain Catastrophizing Scale measure. Pain 155:2360-7
Simons, L E; Pielech, M; Erpelding, N et al. (2014) The responsive amygdala: treatment-induced alterations in functional connectivity in pediatric complex regional pain syndrome. Pain 155:1727-42
Becerra, Lino; Sava, Simona; Simons, Laura E et al. (2014) Intrinsic brain networks normalize with treatment in pediatric complex regional pain syndrome. Neuroimage Clin 6:347-69
Erpelding, Nathalie; Simons, Laura; Lebel, Alyssa et al. (2014) Rapid treatment-induced brain changes in pediatric CRPS. Brain Struct Funct :
Simons, Laura E; Elman, Igor; Borsook, David (2014) Psychological processing in chronic pain: a neural systems approach. Neurosci Biobehav Rev 39:61-78
Erpelding, Nathalie; Sava, Simona; Simons, Laura E et al. (2014) Habenula functional resting-state connectivity in pediatric CRPS. J Neurophysiol 111:239-47

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