lunes, 23 de febrero de 2015

Síndrome de dolor regional complejo en pediatría / Pediatric complex regional pain syndrome

Catéteres multisitio en nervios periféricos para el tratamiento de dolor regional complejo tipo síndrome I.
Successive multisite peripheral nerve catheters for treatment of complex regional pain syndrome type I.
Martin DP, Bhalla T, Rehman S, Tobias JD.
Pediatrics. 2013 Jan;131(1):e323-6. doi: 10.1542/peds.2011-3779. Epub 2012 Dec 10.
Complex regional pain syndrome (CRPS) type I is a painful and disabling syndrome that is accompanied by physical changes in the affected extremity. It generally occurs after trauma, manifesting as pain that is out of proportion to the inciting event. Treatment of the disorder is difficult, with many patients being refractory to multiple pharmacologic regimens. Regional anesthetic techniques, including neuraxial blockade, sympathetic blockade, Bier block, or peripheral nerve catheters, have been used with varying degrees of success. We describe, for the first time, the use of multiple peripheral nerve catheters to treat CRPS type I in a 10-year-old girl when multimodal pharmacologic regimens failed. At separate times, aperipheral nerve catheter was placed to treat CRPS of the distal left lower extremity as well as the right upper extremity. The goal of this therapy was to relieve pain and thereby allow the reinitiation of intensive physical therapy. A continuous infusion of 0.1% ropivacaine was infused via thecatheters for ~60 hours. The patient was subsequently able to participate in physical therapy as well as activities of daily living with improved eating, sleeping, and mood. Although many therapeutic modalities have been tried in CRPS type I, given the debilitating nature of the disorder and the variable response to therapy, new and alternative therapeutic interventions, such as continuous peripheral nerve catheters, are needed.
Redes cerebrales intrínsecas normalizan con el tratamiento en el síndrome de dolor regional complejo pediátrico.
Intrinsic brain networks normalize with treatment in pediatric complex regional pain syndrome.
Becerra L, Sava S, Simons LE, Drosos AM, Sethna N, Berde C, Lebel AA, Borsook D.
Neuroimage Clin. 2014 Aug 10;6:347-69. doi: 10.1016/j.nicl.2014.07.012. eCollection 2014.
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. KEYWORDS: Children; Pain; Resting state; Salience; fMRI
Anestesia y Medicina del Dolor
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