Research and Innovation | Overview
The Pain Treatment Center at Boston Children's Hospital is the most clinically active program of its kind in the world. Since its founding in 1986, the program has been at the helm of research and innovation in pain management. These advances include:
- First ABA-accredited pain fellowship with a specific focus on pediatric pain
- First randomized controlled trial of patient controlled analgesia 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
We take a range of different research approaches, including behavioral studies, genetics, neural circuit architecture, computational modeling, imaging and psychology. Areas of study include:
Prolonged local anesthetics. Researchers have long sought a safe, long-acting, local anesthetic for use in children, which could potentially provide days of pain control without the need for catheters and pumps. Investigators at Boston Children's conducted the preclinical and human Phase 1 clinical trials of neosaxitoxin, the first new local anesthetic in more than 60 years. Our promising findings were published in Anesthesiology in October 2015.
Analgesics in infants and children. Analgesics, including opioids, have important uses in children, as well as risks in specific age groups. We have evaluated designs that balance the unique set of scientific, ethical and practical concerns required for pediatric analgesic trials. Our research investigates psychosocial and pharmacological mechanisms in pediatric analgesia, as well as designs for pediatric subgroups showing different responses to treatment.
Effects of opioids, anesthetics and prolonged sedation in developing infants. Clinicians are concerned about the long-term neurodevelopmental effect of chronic opioid exposure, repeated general anesthesia and prolonged benzodiazepine sedation in the postnatal period. We use non-invasive brain monitoring, quantitative sensory testing tools and behavioral outcome measures to evaluate brain plasticity in response to postnatal drug exposure in both juvenile animal and clinical models.
Industry collaborations. We are collaborating with industry leaders such as Amgen and Biogen to identify drug targets and evaluate novel therapies for pain relief.
The Comfort Ability. We collaborated on an evaluation of this one-day chronic pain management workshop for children. Findings indicate that adolescents demonstrate significant improvements in functionality, depressive symptoms and pain catastrophizing one month after the program and continue making gains over time. Results also show that parents make significant changes in parenting practices and in their beliefs about their adolescents' ability to manage pain one week after the program and continue making gains over time.
Genetics of chronic pain. We are dedicated to studying patients with a variety of pain related disorders in order to learn more about potential underlying genetic mechanisms. Our research involves studying patients with diminished pain sensitivity, erythromelalgia, paroxysmal extreme pain disorder, hereditary sensory and autonomic neuropathy and insensitivity to local anesthetics. We use contemporary methods of gene discovery, including whole exome sequencing, contemporary informatics approaches, and in selected cases, whole genome sequencing.
Complex regional pain syndrome (CRPS) in pediatrics. CRPS is an important cause of pain and disability in adolescents, especially females. We have studied sensory and autonomic physiology and conducted prospective controlled clinical trials of rehabilitative treatments and nerve-blocking interventions for chronic pain conditions such as CRPS. We are also studying pain and functional outcomes of children with chronic pain who are hospitalized and treated with regional anesthesia in Pain Treatment Services.
Long-term changes in peripheral and central pain processing in children with chronic pain. Our group has shown that although chronic pain produces persistent alterations in pain processing, rehabilitative treatment can rapidly improve function, reduce disability, and partially normalize altered patterns of central pain processing in children.
Characterizing overlapping pain conditions in adolescence. Overlapping chronic pain conditions (OCP) are associated with higher levels of functional disability, an increase in anxiety and depression, greater healthcare use and increased financial burden on families and society compared to chronic pain at a single site. We are collaborating with the Boston Children's Pediatric Headache Program Functional Abdominal Pain Clinic on the first comprehensive epidemiological, physiological and psychosocial study of adolescents with OCP.
Post-treatment Lyme disease syndrome. Lyme disease is the most common vector-borne disease in the U.S. We are collaborating with the Division of Infectious Diseases on the first study aiming to evaluate the sensory profile and psychological risk factors of post-treatment Lyme disease syndrome in people ages 12 to 22 years old.