description): Neuropathic pain conditions in adults, including diabetic neuropathy, post-surgical and post-traumatic neuropathies and AIDS-associated neuropathy, produce considerable suffering and disability. Neuropathic pain in children has previously received comparatively less formal study. The Pain Treatment Service at Children's Hospital in Boston has become a referral center for children with many types of neuropathic pain, but especially limb pain associated with signs of abnormal circulation, which has been variously named reflex sympathetic [or neurovascular] dystrophy [RSD/RND], sympathetically maintained pain [SMP], and complex regional pain syndrome type 1 [CRPS1]. Over the past 10 years, >450 children and adolescents with RSD have been treated at the hospital. In 1992, the investigators reported on 2-5 year follow-up of their first 70 patients, and found that: [1] females outnumbered males 6:1, [2] lower extremities were affected five times as often as upper extremities, [3] many patients sustained trauma or overuse injuries in sports, ballet and gymnastics, [4] school absenteeism was extensive, [5] at presentation, most were confined to crutches or wheelchairs [6] >50 percent had resolution of pain and recovery of function with treatment that emphasized active physical therapy, cognitive-behavioral treatments, and family/lifestyle interventions and patient/parent education. The previous studies are limited by retrospective design and by absence of precise measures of motor, sensory, automatic and psychosocial function. In this project, the investigators propose to study pediatric patients with RSD with outcomes measures including: [1] motor functioning, [2] sensory disturbances, including thresholds, [3] cardiac and peripheral autonomic control, and [4] psychosocial functioning, including school attendance/performance. In a randomized prospective trial, we will compare the effectiveness and efficiency of two physical therapy regimens [once per week vs. three times per week]. For patients with persistent disability and pain refractory to our rehabilitative approach, we also propose a clinical trial and paradigm for objectively evaluating responses to sympathetic blockade. The long-range aim is to better understand the causes, exacerbating factors, and determinants of responses to treatment of children with RSD/CRPS].

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
Research Project (R01)
Project #
5R01HD035737-02
Application #
2674135
Study Section
Special Emphasis Panel (ZHD1-RRG-K (07))
Program Officer
Ansel, Beth
Project Start
1997-09-01
Project End
2001-08-31
Budget Start
1998-09-01
Budget End
1999-08-31
Support Year
2
Fiscal Year
1998
Total Cost
Indirect Cost
Name
Children's Hospital Boston
Department
Type
DUNS #
076593722
City
Boston
State
MA
Country
United States
Zip Code
02115
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Berde, Charles B; Sethna, Navil F (2002) Analgesics for the treatment of pain in children. N Engl J Med 347:1094-103
Lee, Benjamin H; Scharff, Lisa; Sethna, Navil F et al. (2002) Physical therapy and cognitive-behavioral treatment for complex regional pain syndromes. J Pediatr 141:135-40
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