Las conexiones cerebrales intrínsecas se normalizan con el tratamiento en el síndrome de dolor regional complejo pediátrica.Intrinsic brain networks normalize with treatment in pediatric complex regional pain syndrome.
Becerra L, Sava S, Simons LE, Drosos AM, Sethna N, Berde C, Lebel AA, Borsook D.
Neuroimage Clin. 2014 Aug 10;6:347-69. doi: 10.1016/j.nicl.2014.07.012. eCollection 2014.
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.
KEYWORDS: Children; Pain; Resting state; Salience; fMR
Referencias de dolor neuropático a un servicio de dolor por cáncer pediátrico multidisciplinario.Neuropathic pain referrals to a multidisciplinary pediatric cancer pain service.
Anghelescu DL, Faughnan LG, Popenhagen MP, Oakes LL, Pei D, Burgoyne LL.
Pain Manag Nurs. 2014 Mar;15(1):126-31. doi: 10.1016/j.pmn.2012.07.006. Epub 2012 Aug 25.
Neuropathic pain (NP) in children with cancer is not well characterized. In a retrospective review of patient data from a 3.5-year period, we describe the prevalence of NP and the characteristics, duration of follow-up, and interventions provided for NP among patients referred to a pediatric oncology center’s pain management service. Fifteen percent (66/439) of all referrals to our pain service were for NP (56/323 patients [17%]; 34 male, 22 female). The NP patient group had 1,401 clinical visits (778 inpatient visits [55.5%] and 623 outpatient visits [44.5%]). Patients with NP had a significantly greater mean number of pain visits per consultation (p = .008) and significantly more days of pain service follow-up (p < .001) than did other patients. The most common cause of NP was cancer treatment rather than the underlying malignancy. Pharmacologic management of NP was complex, often comprising three medications. Nonpharmacologic approaches were used for 57.6% of NP referrals. Neuropathic pain is less frequently encountered than non-NP in children with cancer; nevertheless, it is more difficult to treat, requiring longer follow-up, more clinical visits, complex pharmacologic management, and the frequent addition of nonpharmacologic interventions.
Las consecuencias del dolor en la edad temprana. Plasticidad inducida por daño en las vías del dolorThe consequences of pain in early life: injury-induced plasticity in developing pain pathways.
Schwaller F, Fitzgerald M.
Eur J Neurosci. 2014 Feb;39(3):344-52. doi: 10.1111/ejn.12414.
Pain in infancy influences pain reactivity in later life, but how and why this occurs is poorly understood. Here we review the evidence for developmental plasticity of nociceptive pathways in animal models and discuss the peripheral and central mechanisms that underlie this plasticity. Adults who have experienced neonatal injury display increased pain and injury-induced hyperalgesia in the affected region but mild injury can also induce widespread baseline hyposensitivity across the rest of the body surface, suggesting the involvement of several underlying mechanisms, depending upon the type of early life experience. Peripheral nerve sprouting and dorsal horn central sensitization, disinhibition and neuroimmune priming are discussed in relation to the increased pain and hyperalgesia, while altered descending pain control systems driven, in part, by changes in the stress/HPA axis are discussed in relation to the widespread hypoalgesia. Finally, it is proposed that the endocannabinoid system deserves further attention in the search for mechanisms underlying injury-induced changes in pain processing in infants and children.
Dolor neuropático en niños. Consideraciones especialesNeuropathic pain in children: Special considerations.
Walco GA, Dworkin RH, Krane EJ, LeBel AA, Treede RD.
Mayo Clin Proc. 2010 Mar;85(3 Suppl):S33-41. doi: 10.4065/mcp.2009.0647.
Neuropathic pain is relatively uncommon in children. Although some syndromes closely resemble those found in adults, the incidence and course of the condition can vary substantially in children, depending on developmental status and contextual factors. There are some neuropathic painsyndromes that are rare and relatively unique to the pediatric population. This article discusses the array of neuropathic pain conditions in childrenand available treatment strategies. Data are limited by small numbers and few randomized controlled trials. Research and clinical implications are discussed.