The feasibility and acceptability of research magnetic resonance imaging in adolescents with moderate–severe neuropathic pain (original) (raw)
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Pediatric Rheumatology, 2017
Background: Studies on functional magnetic resonance imaging (fMRI) have shown that adults with musculoskeletal pain syndromes tolerate smaller amount of pressure (pain) as well as differences in brain activation patterns in areas related to pain.The objective of this study was to evaluate, through fMRI, the brain activation in adolescents with idiopathic musculoskeletal pain (IMP) while performing an experimental paradigm of pain. Methods: The study included 10 consecutive adolescents with idiopathic musculoskeletal pain (average age 16.3±1.0) and 10 healthy adolescents age-matched. fMRI exams were performed in a 3 T scanner (Magnetom Trio, Siemens) using an event-related design paradigm. Pressure stimuli were performed in the nondominant hand thumb, divided into two stages, fixed pain and variable pain. The two local Research Ethics Committees (Ethics Committee from Universidade Federal de São Paulo-Brazil, process number 0688/11, on July 1st, 2011 and Ethics Committee from Hospital Israelita Albert Einsten-Brazil, process number 1673, on October 19th, 2011) approved the study. Results: The idiopathic musculoskeletal pain (IMP) group showed a reduced threshold for pain (3.7 kg/cm 2 versus 4. 45 kg/cm 2 , p = 0.005). Control group presented increased bain activation when compared to IMP group in the following areas: thalamus (p = 0.00001), precentral gyrus (p = 0.0004) and middle frontal gyrus (p = 0.03). In intragroup analysis, IMP group showed greater brain activation during the unpredictable stimuli of the variable pain stage, especially in the lingual gyrus (p = 0.0001), frontal lobe (p = 0.0001), temporal gyrus (p = 0.0001) and precentral gyrus (p = 0.03), when compared to predictable stimulus of fixed pain. The same intragroup analysis with the control group showed greater activation during the unpredictable stimuli in regions of the precentral gyrus (p = 0.0001), subcallosal area (p = 0.0001), right and left occipital fusiform gyrus (p = 0.0001; (p = 0.0007), middle gyrus (p = 0.01) and precuneus p = (0.02). Conclusion: Adolescents with idiopathic musculoskeletal pain (IMP) tend to request higher brain function in cognitiveemotional areas when interpreting unpredictable sensory-perceptual situations. Therefore, it is assumed that this difference in pain processing in adolescents with IMP make the subjective experience of pain something more intense and unpleasant.
Peculiarities of neuropathic pain in children
Revista Dor, 2016
BACKGROUND AND OBJECTIVES: In spite of its importance, neuropathic pain is underestimated and undertreated in childhood. Although many conditions causing neuropathic pain in adults are uncommon during childhood, most therapeutic strategies effective for adults were extrapolated for the pediatric population. This study aimed at bringing to light peculiarities of neuropathic pain in children, which shall contribute for its better recognition in childhood and adolescence. CONTENTS: Pubmed, Scielo and Lilacs databases were queried to identify studies and literature reviews on neuropathic pain during childhood and adolescence. CONCLUSION: Neuropathic pain treatment in childhood and adolescence should be multimodal, including pharmacological treatment, rehabilitation and psychological support. Rehabilitation, physiotherapy, occupational therapy and integrative therapies should be part of the integral treatment in childhood and adolescence and vary in a case-by-case basis.
A Review of Adult and Pediatric Neuropathic Pain Assessment Tools
The Clinical Journal of Pain, 2017
Objectives: To identify and summarize the tools currently available for diagnosing and assessing neuropathic pain (NP) in adults and children and to identify areas where further research is required to address deficiencies in the existing tools. Methods: A review of journal articles pertaining to the diagnosis and assessment of NP was conducted. Results: We identified 11 tools for assessing NP in adults and 4 for assessing NP in pediatric patients. Conclusions: This article summarizes the various screening and assessment tools available to clinicians for evaluating NP. Despite the availability of the 15 tools discussed, a deficiency remains, particularly in the pediatric realm. To date, there is no well-validated NP assessment tool for children younger than 5 years, no pediatric NP screening tool that has been validated outside the domain of chemotherapy-induced peripheral neuropathy, and no consistent recommendation regarding the optimal tool to use with pediatric patients who have...
Challenges of functional imaging research of pain in children
Molecular Pain, 2009
Functional imaging has revolutionized the neurosciences. In the pain field it has dramatically altered our understanding of how the brain undergoes significant functional, anatomical and chemical changes in patients with chronic pain. However, most studies have been performed in adults. Because functional imaging is non-invasive and can be performed in awake individuals, applications in children have become more prevalent, but only recently in the pain field. Measures of changes in the brains of children have important implications in understanding neural plasticity in response to acute and chronic pain in the developing brain. Such findings may have implications for treatments in children affected by chronic pain and provide novel insights into chronic pain syndromes in adults. In this review we summarize this potential and discuss specific concerns related to the imaging of pain in children.
The epidemiology of chronic pain in children and adolescents revisited: A systematic review
Pain, 2011
Chronic and recurrent pain not associated with a disease is very common in childhood and adolescence, but studies of pain prevalence have yielded inconsistent findings. This systematic review examined studies of chronic and recurrent pain prevalence to provide updated aggregated prevalence rates. The review also examined correlates of chronic and recurrent pain such as age, sex, and psychosocial functioning. Studies of pain prevalence rates in children and adolescents published in English or French between 1991 and 2009 were identified using EMBASE, Medline, CINAHL, and PsycINFO databases. Of 185 published papers yielded by the search, 58 met inclusion criteria and were reviewed, and 41 were included in the review. Two independent reviewers screened papers for inclusion, extracted data, and assessed the quality of studies. Prevalence rates ranged substantially, and were as follows: headache: 8-83%; abdominal pain: 4-53%; back pain: 14-24%; musculoskeletal pain: 4-40%; multiple pains: 4-49%; other pains: 5-88%. Pain prevalence rates were generally higher in girls and increased with age for most pain types. Lower socioeconomic status was associated with higher pain prevalence especially for headache. Most studies did not meet quality criteria.
Journal of Pain Research, 2014
Objectives: This study was designed to investigate whether an individual and parental history of functional pain syndromes (FPS) is found more often in adolescents suffering from chronic pain than in their pain-free peers. Methods: Our case-control study involved 101 adolescents aged 10-18 years. Cases were 45 patients of the Chronic Pain Clinic at Sydney Children's Hospital with diverse chronic pain disorders. Controls consisted of 56 adolescent volunteers who did not have chronic pain. Adolescents and their parents filled out questionnaires assessing demographic data as well as known and potential risk factors for chronic pain. A history of FPS was assessed by questionnaire, including restless legs syndrome (RLS). Chi-squared tests and t-tests were used to investigate univariate associations between chronic pain in adolescents and lifetime prevalence of FPS. Logistic regression was used to test multivariate associations, while controlling for possible confounders. Results: Migraine, non-migraine headaches, recurrent abdominal pain (RAP), and RLS were reported significantly more frequently in cases than controls (P-values of 0.01, ,0.001, 0.01, and 0.03, respectively). Parental migraine, RAP, and RLS were also significantly associated with adolescent chronic pain in the multivariate analyses. Individual history of migraine, nonmigraine headaches, and RAP, along with parental history of RAP and depression significantly accounted for 36%-49% of variance in chronic pain. Other associations with chronic pain were generally in accordance with previous reports. Discussion: It may be helpful when assessing a child who has chronic pain or is at risk of chronic pain, to enquire about these associations. Based on the current findings, an individual history of migraine, non-migraine headaches, and RAP, as well as parental migraine, RAP, and RLS are symptoms that are of particular relevance to assess.
Pain in Youths With Neuromuscular Disease
American Journal of Hospice and Palliative Medicine, 2009
To examine the prevalence and characteristics of pain in children with neuromuscular disease (NMD), 42 youths with NMD underwent a comprehensive evaluation including a detailed intake interview and structured questionnaire that included demographic and functional data. Youths who reported chronic pain were further queried about pain characteristics, locations, and intensity using an 11-point numerical rating scale and a modified Brief Pain Inventory (BPI). The sample consisted of 24 males (57%) and 18 females (43%), ages ranging from 9 to 20 years (M = 14.8, SD = 2.96). Participants included 14 (37%) with Duchenne-muscular dystrophy, 6 (14%) with myotonic dystrophy, 2 (5%) with Becker dystrophy, 2 (5%) with limb-girdle dystrophy, 2 (5%) with congenital muscular dystrophy, 1 (2%) facioscapulohumeral, and 15 (36%) were classified as "other NMD." Twenty-one (50%) were ambulatory; 26 (62%) used power wheelchairs/scooters, 9 (2%) used manual wheelchairs, 3 (.07%) used crutches/canes, and 1 (2%) used a walker. A total of 23 (55%) of the youths reported having chronic pain. Current pain intensity was 1.30(range=0-6), mean pain intensity over the past week was 2.39 (range = 0-7), mean pain duration was 8.75 hours (SD=12.84). Pain in the legs was most commonly reported and 83% reported using pain medications. This study indicates that chronic pain is a significant problem in youths with NMD. These data strongly support making comprehensive pain assessment and management an integral part of the standard of care for youths with NMD.
Magnetic Resonance Imaging of Back Pain in Young Population
Journal of Evolution of Medical and Dental Sciences, 2014
BACKGROUND: Low back pain in young patients represents an area of particular challenge and importance to referring physicians. Although plain radiography remains initial imaging tool, MRI due to its inherent high quality soft tissue contrast resolution, lack of ionizing radiation and rare requirement of contrast media remains invaluable modality to evaluate back pain in young patients. AIMS: The role of MRI in evaluation of various lesions of spine, inter vertebral discs and spinal canal in young patients (3-17 years of age). MATERIALS & METHODS: This was a prospective study done from on young patients (total 35 patients) who presented with back pain are evaluated with MRI. Patients advised MRI spine for complaints other than back pain and uncooperative patients were excluded from the study. The study was performed using GE 1.5T and Siemen's 3.0T MRI machines. RESULTS: Although significant number of children and adolescents who presented with back pain did not show any significant abnormality on MRI, the most common etiology in this study was disc disease and herniation. This was immediately followed by second most common cause as sacroilitis and spondylolysis with or without listhesis. Scoliosis, spinal trauma and infective etiologies were third most common cause of back pain in this study. Neoplastic conditions and congenital anomalies were found among the rare causes of back pain in children and adolescents in our study. CONCLUSION: Back pain is common in children and adolescents and its incidence increases with age. MRI remains main stay of spinal imaging to evaluate various pathologies of vertebrae, bone marrow, discs, ligaments, spinal cord and sacroiliac joints.
Pain in children and adolescents: a common experience
Pain, 2000
Little is known about the epidemiology of pain in children. We studied the prevalence of pain in Dutch children aged from 0 to 18 years in the open population, and the relationship with age, gender and pain parameters. A random sample of 1300 children aged 0±3 years was taken from the register of population in Rotterdam, The Netherlands. In the Rotterdam area, 27 primary schools and 14 secondary schools were selected to obtain a representative sample of 5336 children aged 4±18 years. Depending on the age of the child, a questionnaire was either mailed to the parents (0±3 years) or distributed at school (4±18 years). Of 6636 children surveyed, 5424 (82%) responded; response rates ranged from 64 to 92%, depending on the subject age and who completed the questionnaire. Of the respondents, 54% had experienced pain within the previous 3 months. Overall, a quarter of the respondents reported chronic pain (recurrent or continuous pain for more than 3 months). The prevalence of chronic pain increased with age, and was signi®cantly higher for girls (P , 0:001). In girls, a marked increase occurred in reporting chronic pain between 12 and 14 years of age. The most common types of pain in children were limb pain, headache and abdominal pain. Half of the respondents who had experienced pain reported to have multiple pain, and one-third of the chronic pain sufferers experienced frequent and intense pain. These multiple pains and severe pains were more often reported by girls (P , 0:001). The intensity of pain was higher in the case of chronic pain (P , 0:001) and multiple pains (P , 0:001), and for chronic pain the intensity was higher for girls (P , 0:001). These ®ndings indicate that chronic pain is a common complaint in childhood and adolescence. In particular, the high prevalence of severe chronic pain and multiple pain in girls aged 12 years and over calls for follow-up investigations documenting the various bio-psycho-social factors related to this pain.