Innovations and Research

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Pain Treatment Services at Boston Children's Hospital, a division of the hospital's Department of Anesthesia, Perioperative and Pain Medicine and which operates the Mayo Family Pediatric Pain Rehabilitation Clinic (PPRC), was established in 1986 by Charles Berde, MD, PhDNavil Sethna, MC, ChB; Bruce Masek, PhD; Claire McCarthy, MD, and their colleagues as the first multidisciplinary program in the world for pediatric acute and chronic pain management. Our program remains the most clinically active program of its kind in the world.

Innovations from our program over the past 3 decades include the following:

  • First multidisciplinary pediatric acute and chronic pain management program
  • First and only all-day-hospital intensive pediatric pain rehabilitation program in the U.S.
  • First AMA -accredited pain fellowship with a specific focus on pediatric pain
  • First randomized controlled trial of patient controlled analgesia (PCA) in pediatrics
  • First prospective controlled study of rehabilitative treatment of CRPS/RSD in pediatrics
  • First study of sensory abnormalities in pediatric CRPS/RSD using quantitative sensory testing
  • First study of cardiovascular autonomic regulation in pediatric CRPS/RSD
  • First study of brain imaging using fMRI in pediatric CRPS/RSD
  • First randomized crossover trial of lumbar sympathetic lidocaine and intravenous lidocaine in pediatric CRPS/RSD.
  • Development of novel cognitive behavioral treatments for children with chronic pain including interventions to address school impairment, exposure based treatments to reduce fear of pain, and brief CBT workshops. 

Clinical Studies

PPRC clinicians are involved in several clinical studies, such as:.

Brain fMRI for Children and Adolescents with Complex Regional Pain Syndromes (CRPS I and II)
Alyssa Lebel MD, Charles Berde MD PhD, Laura Chastain, David Borsook MD, Lino Becerra MD

CRPS in pediatric patients has several unique differences from the adult condition. Children can have recurrent episodes after apparent complete resolution of the signs and symptoms, sometimes with and sometimes without any inciting injury. Pediatric patients are unique among individuals with CRPS, as they are generally free of additional complicating neuropathic pain conditions and are developmentally more likely to demonstrate robust neuronal plasticity. CRPS remains, to date, clinically apparent but poorly defined at an anatomic and pathophysiologic level. Imaging of pain in pediatric patients with CRPS may provide a previously unavailable window into the central nervous system changes of challenging chronic pain disorders. Patients (9-20 years old) with CRPS affecting the lower extremity were recruited to the study. Subjects had pre-scanning thresholds measured to determine that the pain stimuli would be tolerable during the scanning. Mechanical stimuli (e.g. cold exposure, brushing) were applied to the affected region of the involved limb and the corresponding mirror region of the unaffected limb.

Other Pain Related Clinical Studies

  • School Impairment Among Adolescents with Chronic Pain
  • Assessing Satisfaction and Follow-up with Pain Clinic Recommendations
  • Attitudes Toward Pain in Pediatric Pain Patients: Pilot Study
  • Retrospective Review of Outcomes in Pediatric Lumbar Disc Herniation
  • Assessment of Pain Reactivity Induced by the Cold Pressor Test in Children with Migraines
  • Assessment and Treatment of Recurrent Pain Syndromes in Children
For more information on whether your child might benefit from inclusion in a study, please contact us.

To see a list of our most recent publications, please visit: Department Publications

The future of pediatrics will be forged by thinking differently, breaking paradigms and joining together in a shared vision of tackling the toughest challenges before us.”
- Sandra L. Fenwick, President and CEO

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