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

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.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Mentored Patient-Oriented Research Career Development Award (K23)
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Pediatrics Subcommittee (CHHD)
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Haverkos, Lynne
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Children's Hospital Boston
United States
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Basch, M C; Chow, E T; Logan, D E et al. (2018) Cumulative effects of multiple pain sites in youth with chronic pain. Eur J Pain 22:1134-1141
Simons, Laura E; Sieberg, Christine B; Conroy, Caitlin et al. (2018) Children With Chronic Pain: Response Trajectories After Intensive Pain Rehabilitation Treatment. J Pain 19:207-218
Sieberg, Christine B; Manganella, Juliana; Manalo, Gem et al. (2017) Predicting Postsurgical Satisfaction in Adolescents With Idiopathic Scoliosis: The Role of Presurgical Functioning and Expectations. J Pediatr Orthop 37:e548-e551
Simons, Laura E; Basch, Molly C (2016) State of the art in biobehavioral approaches to the management of chronic pain in childhood. Pain Manag 6:49-61
Erpelding, Nathalie; Simons, Laura; Lebel, Alyssa et al. (2016) Rapid treatment-induced brain changes in pediatric CRPS. Brain Struct Funct 221:1095-111
Chow, Erika T; Otis, John D; Simons, Laura E (2016) The Longitudinal Impact of Parent Distress and Behavior on Functional Outcomes Among Youth With Chronic Pain. J Pain 17:729-38
Simons, Laura E (2016) Fear of pain in children and adolescents with neuropathic pain and complex regional pain syndrome. Pain 157 Suppl 1:S90-7
Simons, Laura E; Goubert, Liesbet; Vervoort, Tine et al. (2016) Circles of engagement: Childhood pain and parent brain. Neurosci Biobehav Rev 68:537-546
Basch, Molly C; Chow, Erika T; Logan, Deirdre E et al. (2015) Perspectives on the clinical significance of functional pain syndromes in children. J Pain Res 8:675-86
Simons, Laura E; Smith, Allison; Ibagon, Camila et al. (2015) Pediatric Pain Screening Tool: rapid identification of risk in youth with pain complaints. Pain 156:1511-8

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