title: Rapid treatment-induced brain changes in pediatric CRPS.
abstract: To date, brain structure and function changes in children with complex regional pain syndrome (CRPS) as a result of disease and treatment remain unknown. Here, we investigated (a) gray matter (GM) differences between patients with CRPS and healthy controls and (b) GM and functional connectivity (FC) changes in patients following intensive interdisciplinary psychophysical pain treatment. Twenty-three patients (13 females, 9 males; average age ± SD = 13.3 ± 2.5 years) and 21 healthy sex- and age-matched controls underwent magnetic resonance imaging. Compared to controls, patients had reduced GM in the primary motor cortex, premotor cortex, supplementary motor area, midcingulate cortex, orbitofrontal cortex, dorsolateral prefrontal cortex (dlPFC), posterior cingulate cortex, precuneus, basal ganglia, thalamus, and hippocampus. Following treatment, patients had increased GM in the dlPFC, thalamus, basal ganglia, amygdala, and hippocampus, and enhanced FC between the dlPFC and the periaqueductal gray, two regions involved in descending pain modulation. Accordingly, our results provide novel evidence for GM abnormalities in sensory, motor, emotional, cognitive, and pain modulatory regions in children with CRPS. Furthermore, this is the first study to demonstrate rapid treatment-induced GM and FC changes in areas implicated in sensation, emotion, cognition, and pain modulation.
authors.affiliation: P.A.I.N. Group, Boston Children's Hospital, Center for Pain and the Brain, 9 Hope Avenue, Waltham, MA, 02453, USA. nathalie.erpelding@gmail.com.|Harvard Medical School, Boston, MA, USA. nathalie.erpelding@gmail.com.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Erpelding
authors.affiliation: P.A.I.N. Group, Boston Children's Hospital, Center for Pain and the Brain, 9 Hope Avenue, Waltham, MA, 02453, USA.|Harvard Medical School, Boston, MA, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Simons
authors.affiliation: P.A.I.N. Group, Boston Children's Hospital, Center for Pain and the Brain, 9 Hope Avenue, Waltham, MA, 02453, USA.|Harvard Medical School, Boston, MA, USA.
authors.forename: Alyssa
authors.initials: A
authors.lastname: Lebel
authors.affiliation: P.A.I.N. Group, Boston Children's Hospital, Center for Pain and the Brain, 9 Hope Avenue, Waltham, MA, 02453, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Serrano
authors.affiliation: P.A.I.N. Group, Boston Children's Hospital, Center for Pain and the Brain, 9 Hope Avenue, Waltham, MA, 02453, USA.
authors.forename: Melissa
authors.initials: M
authors.lastname: Pielech
authors.affiliation: Harvard Medical School, Boston, MA, USA.|Department of Radiology, Boston Children's Hospital, Boston, MA, USA.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Prabhu
authors.affiliation: P.A.I.N. Group, Boston Children's Hospital, Center for Pain and the Brain, 9 Hope Avenue, Waltham, MA, 02453, USA.|Harvard Medical School, Boston, MA, USA.|Massachusetts General Hospital, Boston, MA, USA.|McLean Hospital, Belmont, MA, USA.
authors.forename: Lino
authors.initials: L
authors.lastname: Becerra
authors.affiliation: P.A.I.N. Group, Boston Children's Hospital, Center for Pain and the Brain, 9 Hope Avenue, Waltham, MA, 02453, USA.|Harvard Medical School, Boston, MA, USA.|Massachusetts General Hospital, Boston, MA, USA.|McLean Hospital, Belmont, MA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Borsook
mesh_terms: D000293:Adolescent; D000679:Amygdala / Q000503:physiopathology; D001479:Basal Ganglia / Q000503:physiopathology; D001921:Brain / Q000503:physiopathology; D016022:Case-Control Studies; D002648:Child; D020918:Complex Regional Pain Syndromes / Q000503:physiopathology*; D063132:Connectome; D005260:Female; D066128:Gray Matter / Q000503:physiopathology*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D009044:Motor Cortex / Q000503:physiopathology; D010146:Pain / Q000503:physiopathology; D010296:Parietal Lobe / Q000503:physiopathology; D017397:Prefrontal Cortex / Q000503:physiopathology
keywords: Children; Chronic pain; Cortical thickness; Functional connectivity; Hippocampus; Neuropathic pain; Periaqueductal gray; Prefrontal cortex; Voxel-based morphometry