Pediatric Pain Rehabilitation Center

Among the innovations from our program over the past 22 years include the following firsts:

• First multidisciplinary pediatric acute and chronic pain management program
• First ABA-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 normal reference ranges for quantitative sensory testing (QST) in healthy children and adolescents
• First study of sensory abnormalities in pediatric CRPS/RSD using QST
• First study of cardiovascular autonomic regulation in pediatric CRPS/RSD
• First study of brain imaging using fMRI in pediatric CRPS/RSD
• First case series on patterns of opioid dose escalation in pediatric advanced cancer
• First study of safety and recovery parameters for midazolam for sedation for pediatric oncology procedures
• First case series on regional anesthesia for refractory pain in children with advanced cancer
• First study of the safety of postoperative use of ketorolac in children
• First study using transfer function analysis of heart rate variability to examine
cardiovascular autonomic regulation in infants undergoing hernia repairs under spinal anesthesia
• First randomized controlled trial of methadone for postoperative pain in children
• First study of the pharmacology of the local anesthetic 2-chloroprocaine in infants
• First randomized crossover trial of lumbar sympathetic lidocaine and intravenous lidocaine in pediatric CRPS/RSD.
• First double-blind study using a crossover paradigm to establish steady state potency ratio of morphine to hydromorphone in children

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 prescanning 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.

• 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