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Chronic Post-Ischemia Pain Model for Complex Regional Pain Syndrome Type-I in Rats
Published on: January 21, 2020
Intrinsic brain networks normalize with treatment in pediatric complex regional pain syndrome
Lino Becerra1, Simona Sava2, Laura E Simons3
1Pain/Analgesia Imaging Neuroscience (P.A.I.N.) Group, Boston Children's Hospital, 300 Longwood Ave., Boston, MA 02115, USA ; Department of Anesthesiology, Boston Children's Hospital, 300 Longwood Ave., Boston, MA 02115, USA ; Department of Radiology, Boston Children's Hospital, 300 Longwood Ave., Boston, MA 02115, USA.
Insights
Pediatric complex regional pain syndrome (P-CRPS) brain networks show significant differences in children and adolescents. Intensive treatment rapidly altered these brain networks, reducing pain and improving function.
Area of Science:
- Neuroscience
- Pediatric Pain Research
- Clinical Psychology
Background:
- Pediatric complex regional pain syndrome (P-CRPS) is a neuropathic pain condition in children and adolescents.
- P-CRPS often resolves spontaneously or with treatment, making it a unique model for studying chronic pain.
- Brain network alterations are implicated in chronic pain conditions.
Purpose of the Study:
- To investigate intrinsic brain network changes in pediatric complex regional pain syndrome (P-CRPS) before and after treatment.
- To compare brain network differences between P-CRPS patients and healthy controls.
- To correlate changes in brain network connectivity with clinical improvements.
Main Methods:
- Resting-state functional magnetic resonance imaging (rs-fMRI) was used to measure brain network activity.
- Participants included children and adolescents diagnosed with P-CRPS and matched healthy controls.
- A brief, intensive physical and psychological treatment program was administered to P-CRPS patients.
Main Results:
- P-CRPS patients exhibited distinct intrinsic brain network differences compared to controls, notably in fronto-parietal, salience, default mode, central executive, and sensorimotor networks.
- Following treatment, patients showed significant symptom reduction and improved physical functioning (pain and motor skills).
- Reduced connectivity in salience, central executive, default mode, and sensorimotor networks correlated with decreased pain levels post-treatment.
Conclusions:
- Pediatric complex regional pain syndrome involves widespread alterations in intrinsic brain networks.
- Intensive treatment leads to rapid, global changes in brain network connectivity.
- Brain network analysis offers a potential method for assessing treatment efficacy in P-CRPS.
Abstract:
Pediatric complex regional pain syndrome (P-CRPS) offers a unique model of chronic neuropathic pain as it either resolves spontaneously or through therapeutic interventions in most patients. Here we evaluated brain changes in well-characterized children and adolescents with P-CRPS by measuring resting state networks before and following a brief (median = 3 weeks) but intensive physical and psychological treatment program, and compared them to matched healthy controls. Differences in intrinsic brain networks were observed in P-CRPS compared to controls before treatment (disease state) with the most prominent differences in the fronto-parietal, salience, default mode, central executive, and sensorimotor networks. Following treatment, behavioral measures demonstrated a reduction of symptoms and improvement of physical state (pain levels and motor functioning). Correlation of network connectivities with spontaneous pain measures pre- and post-treatment indicated concomitant reductions in connectivity in salience, central executive, default mode and sensorimotor networks (treatment effects). These results suggest a rapid alteration in global brain networks with treatment and provide a venue to assess brain changes in CRPS pre- and post-treatment, and to evaluate therapeutic effects.
