title: Transient and persistent pain induced connectivity alterations in pediatric complex regional pain syndrome.
abstract: Evaluation of pain-induced changes in functional connectivity was performed in pediatric complex regional pain syndrome (CRPS) patients. High field functional magnetic resonance imaging was done in the symptomatic painful state and at follow up in the asymptomatic pain free/recovered state. Two types of connectivity alterations were defined: (1) Transient increases in functional connectivity that identified regions with increased cold-induced functional connectivity in the affected limb vs. unaffected limb in the CRPS state, but with normalized connectivity patterns in the recovered state; and (2) Persistent increases in functional connectivity that identified regions with increased cold-induced functional connectivity in the affected limb as compared to the unaffected limb that persisted also in the recovered state (recovered affected limb versus recovered unaffected limb). The data support the notion that even after symptomatic recovery, alterations in brain systems persist, particularly in amygdala and basal ganglia systems. Connectivity analysis may provide a measure of temporal normalization of different circuits/regions when evaluating therapeutic interventions for this condition. The results add emphasis to the importance of early recognition and management in improving outcome of pediatric CRPS.
authors.affiliation: Pain and Analgesia Imaging Neuroscience P.A.I.N. Group, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, United States of America. Clas.Linnman@childrens.harvard.edu
authors.forename: Clas
authors.initials: C
authors.lastname: Linnman
authors.forename: Lino
authors.initials: L
authors.lastname: Becerra
authors.forename: Alyssa
authors.initials: A
authors.lastname: Lebel
authors.forename: Charles
authors.initials: C
authors.lastname: Berde
authors.forename: P Ellen
authors.initials: PE
authors.lastname: Grant
authors.forename: David
authors.initials: D
authors.lastname: Borsook
mesh_terms: D000293:Adolescent; D001921:Brain / Q000473:pathology / Q000503:physiopathology*; D002648:Child; D003080:Cold Temperature / Q000009:adverse effects; D020918:Complex Regional Pain Syndromes / Q000473:pathology / Q000503:physiopathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D010100:Oxygen / Q000097:blood; D010146:Pain / Q000503:physiopathology; D013997:Time Factors
chemical_list: D010100:Oxygen