Intrinsic brain networks normalize with treatment in pediatric complex regional pain syndrome.
Pediatric complex regional pain syndrome (P-CRPS) offers a unique model of chronic neuropathic pain as it either resolves spontaneously or through therapeutic interventions in most patients. Here we evaluated brain changes in well-characterized children and adolescents with P-CRPS by measuring resting state networks before and following a brief (median = 3 weeks) but intensive physical and psychological treatment program, and compared them to matched healthy controls. Differences in intrinsic brain networks were observed in P-CRPS compared to controls before treatment (disease state) with the most prominent differences in the fronto-parietal, salience, default mode, central executive, and sensorimotor networks. Following treatment, behavioral measures demonstrated a reduction of symptoms and improvement of physical state (pain levels and motor functioning). Correlation of network connectivities with spontaneous pain measures pre- and post-treatment indicated concomitant reductions in connectivity in salience, central executive, default mode and sensorimotor networks (treatment effects). These results suggest a rapid alteration in global brain networks with treatment and provide a venue to assess brain changes in CRPS pre- and post-treatment, and to evaluate therapeutic effects.
Pain/Analgesia Imaging Neuroscience (P.A.I.N.) Group, Boston Children's Hospital, 300 Longwood Ave., Boston, MA 02115, USA ; Department of Anesthesiology, Boston Children's Hospital, 300 Longwood Ave., Boston, MA 02115, USA ; Department of Radiology, Boston Children's Hospital, 300 Longwood Ave., Boston, MA 02115, USA.
Lino
L
Becerra
Pain/Analgesia Imaging Neuroscience (P.A.I.N.) Group, Boston Children's Hospital, 300 Longwood Ave., Boston, MA 02115, USA.
Simona
S
Sava
Pain/Analgesia Imaging Neuroscience (P.A.I.N.) Group, Boston Children's Hospital, 300 Longwood Ave., Boston, MA 02115, USA ; Department of Anesthesiology, Boston Children's Hospital, 300 Longwood Ave., Boston, MA 02115, USA.
Laura E
LE
Simons
Pain/Analgesia Imaging Neuroscience (P.A.I.N.) Group, Boston Children's Hospital, 300 Longwood Ave., Boston, MA 02115, USA.
Athena M
AM
Drosos
Department of Anesthesiology, Boston Children's Hospital, 300 Longwood Ave., Boston, MA 02115, USA.
Navil
N
Sethna
Department of Anesthesiology, Boston Children's Hospital, 300 Longwood Ave., Boston, MA 02115, USA.
Charles
C
Berde
Pain/Analgesia Imaging Neuroscience (P.A.I.N.) Group, Boston Children's Hospital, 300 Longwood Ave., Boston, MA 02115, USA ; Department of Anesthesiology, Boston Children's Hospital, 300 Longwood Ave., Boston, MA 02115, USA.
Alyssa A
AA
Lebel
Pain/Analgesia Imaging Neuroscience (P.A.I.N.) Group, Boston Children's Hospital, 300 Longwood Ave., Boston, MA 02115, USA ; Department of Anesthesiology, Boston Children's Hospital, 300 Longwood Ave., Boston, MA 02115, USA.
David
D
Borsook
D000293:Adolescent; D001921:Brain / Q000503:physiopathology*; D001931:Brain Mapping; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009415:Nerve Net / Q000503:physiopathology*; D009483:Neuropsychological Tests; D012019:Reflex Sympathetic Dystrophy / Q000503:physiopathology*; D012146:Rest
Children; Pain; Resting state; Salience; fMRI