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Faria V, Talbert C, Goturi N, Borsook D, Lebel A, Kaptchuk TJ, Kirsch I, Kelley JM, Moulton EA. Placebos in pediatrics: A cross-sectional survey investigating physicians' perspectives. J Psychosom Res 2023; 172:111421. [PMID: 37354748 DOI: 10.1016/j.jpsychores.2023.111421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/07/2023] [Accepted: 06/18/2023] [Indexed: 06/26/2023]
Abstract
OBJECTIVE Placebo responses are significantly higher in children than in adults, suggesting a potential underused treatment option in pediatric care. To facilitate the clinical translation of these beneficial effects, we explored physicians' current practice, opinions, knowledge, and likelihood of recommending placebos in the future. METHODS A cross-sectional web-based survey administered by REDCap was conducted at Boston Children's Hospital between October 2021 and March 2022. Physicians (n = 1157) were invited to participate through an email containing a link to a 23-item survey designed to assess physicians' attitudes and perceptions towards the clinical use of placebo in pediatrics. RESULTS From 207 (18%) returned surveys, 109 (9%) were fully completed. Most respondents (79%) believed that enhancing the therapeutic components that contribute to the placebo response may be a way of improving pediatric care. However, whereas most (62%) found placebo treatments permissible, only one-third reported recommending them. In pediatrics, placebos are typically introduced as a medicine that "might help" (43%). The most common treatments recommended to enhance placebo effects are physical therapy, vitamins, and over-the-counter analgesics. Physicians most frequently recommend placebos for occasional pain, headaches, and anxiety disorders. Finally, the great majority of physicians (87%) stated they would be more likely to recommend placebo treatments if there were safety and ethical guidelines for open-label placebos. CONCLUSIONS Placebo treatments seem permissible to physicians in pediatric care, but the development of safety and ethical guidelines may be necessary before physicians systematically incorporate the benefits of the placebo effect in pediatrics.
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Affiliation(s)
- Vanda Faria
- Brain and Eye Pain Imaging Lab, Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Department of Psychology, Uppsala University, Uppsala, Sweden; Department of Otorhinolaryngology, Smell & Taste Clinic, TU Dresden, Dresden, Germany; Program in Placebo Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| | - Cameron Talbert
- Brain and Eye Pain Imaging Lab, Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nathan Goturi
- Brain and Eye Pain Imaging Lab, Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - David Borsook
- Departments of Psychiatry and Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Alyssa Lebel
- Division of Pain Medicine, Department of Anesthesiology, Boston Children's Hospital, Boston, MA, USA
| | - Ted J Kaptchuk
- Program in Placebo Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Irving Kirsch
- Program in Placebo Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - John M Kelley
- Program in Placebo Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Psychology, Endicott College, Beverly, MA, USA
| | - Eric A Moulton
- Brain and Eye Pain Imaging Lab, Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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2
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Wilcox SL, Nelson S, Ludwick A, Youssef AM, Lebel A, Beccera L, Burstein R, Borsook D. Hippocampal volume changes across developmental periods in female migraineurs. Neurobiol Pain 2023; 14:100137. [PMID: 38099279 PMCID: PMC10719534 DOI: 10.1016/j.ynpai.2023.100137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/22/2023] [Accepted: 06/23/2023] [Indexed: 12/17/2023]
Abstract
Brain-related plasticity can occur at a significant rate varying on the developmental period. Adolescence in particular has been identified as a period of growth and change across the structure and function of the nervous system. Notably, research has identified migraines as common in both pediatric and adult populations, but evidence suggests that the phenotype for migraines may differ in these cohorts due to the unique needs of each developmental period. Accordingly, primary aims of this study were to define hippocampal structure in females (7-27 years of age) with and without migraine, and to determine whether this differs across developmental stages (i.e., childhood, adolescence, and young adulthood). Hippocampal volume was quantified based on high-resolution structural MRI using FMRIB's Integrated Registration and Segmentation Tool. Results indicated that migraine and age may have an interactional relationship with hippocampal volume, such that, while hippocampal volumes were lower in female migraineurs (compared to age-matched controls) during childhood and adolescence, this contrast differed during young adulthood whereby hippocampal volumes were higher in migraineurs (compared to age-matched controls). Subsequent vertex analysis localized this interaction effect in hippocampal volume to displacement of the anterior hippocampus. The transition of hippocampal volume during adolescent development in migraineurs suggests that hippocampal plasticity may dynamically reflect components of migraine that change over the lifespan, exerting possible altered responsivity to stress related to migraine attacks thus having physiological expression and psychosocial impact.
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Affiliation(s)
- Sophie L. Wilcox
- Center for Pain and the Brain, Harvard Medical School, Boston, MA, USA
| | - Sarah Nelson
- Department of Psychiatry, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Allison Ludwick
- Center for Pain and the Brain, Harvard Medical School, Boston, MA, USA
| | - Andrew M. Youssef
- Department of Anatomy and Histology, The University of Sydney, Sydney, NSW, Australia
| | - Alyssa Lebel
- Center for Pain and the Brain, Harvard Medical School, Boston, MA, USA
- Pediatric Headache Program, Boston Children's Hospital, Waltham, MA, USA
| | - Lino Beccera
- Center for Pain and the Brain, Harvard Medical School, Boston, MA, USA
- Invicro, Boston, MA, USA
| | - Rami Burstein
- Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - David Borsook
- Department of Psychiatry and Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
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3
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Belzile D, Auclair A, Roberge J, Piché ME, Lebel A, Pettigrew M, Marceau S, Biertho L, Poirier P. Heart rate variability after bariatric surgery: The add-on value of exercise. Eur J Sport Sci 2023; 23:415-422. [PMID: 34890532 DOI: 10.1080/17461391.2021.2017488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To assess the impact of bariatric surgery and an added supervised exercise training programme on heart rate variability (HRV) in patients with severe obesity. METHODS Fifty-nine patients who underwent bariatric surgery were randomised in the post-operative period to a 12-week supervised exercise training programme (moderate intensity combination aerobic/resistance exercise training programme) or a control group. Indices of HRV including time-domain, spectral-domain, and nonlinear parameters were measured preoperatively, and at 3, 6, and 12 months. RESULTS After the surgical procedure, both groups improved anthropometric parameters. Type 2 diabetes, hypertension, and dyslipidemia resolutions were similar between groups. Total body weight loss at 6 and 12 months were also comparable between groups (6 months: 28 ± 6 vs. 30 ± 6%; 12 months: 38 ± 9 vs. 38 ± 10%; control vs. intervention group respectively). Bariatric surgery improved HRV parameters at 12 months compared to the pre-operative values in the intervention group: standard deviation of R-R interval (SDNN) (156.0 ± 46.4 vs. 122.6 ± 33.1 ms), low frequency (LF) (6.3 ± 0.8 vs. 5.8 ± 0.7 ms2), and high frequency (HF) (5.1 ± 0.8 vs. 4.7 ± 0.9 ms2) (all p<0.001). For the control patients, similar improvements in SDNN (150.0 ± 39.4 vs. 118.8 ± 20.1 ms), LF (6.1 ± 0.9 vs. 5.7 ± 0.8 ms2), and HF (5.0 ± 0.9 vs. 4.7 ± 0.9 ms2) were obtained (all p<0.001). However, there was no add-on impact of the supervised exercise training programme on HRV after 12 months (p>0.05 for all HRV parameters). CONCLUSION Bariatric surgery is associated with an improvement in HRV. A supervised exercise training programme in the post-operative period did not modulate further the benefits of bariatric surgery regarding HRV parameters.
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Affiliation(s)
- D Belzile
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Canada
| | - A Auclair
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Canada
| | - J Roberge
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Canada
| | - M E Piché
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Canada.,Faculty of medicine, Laval University, Québec, Canada
| | - A Lebel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Canada
| | - M Pettigrew
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Canada.,Faculty of pharmacy, Laval University, Québec, Canada
| | - S Marceau
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Canada.,Faculty of medicine, Laval University, Québec, Canada
| | - L Biertho
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Canada.,Faculty of medicine, Laval University, Québec, Canada
| | - P Poirier
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Canada.,Faculty of pharmacy, Laval University, Québec, Canada
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4
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Holmes SA, Staffa SJ, Karapanagou A, Lopez N, Karian V, Borra R, Zurakowski D, Lebel A, Borsook D. Biological laterality and peripheral nerve DTI metrics. PLoS One 2021; 16:e0260256. [PMID: 34914714 PMCID: PMC8675689 DOI: 10.1371/journal.pone.0260256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 11/05/2021] [Indexed: 11/18/2022] Open
Abstract
Background and purpose Clinical comparisons do not usually take laterality into account and thus may report erroneous or misleading data. The concept of laterality, well evaluated in brain and motor systems, may also apply at the level of peripheral nerves. Therefore, we sought to evaluate the extent to which we could observe an effect of laterality in MRI-collected white matter indices of the sciatic nerve and its two branches (tibial and fibular). Materials and methods We enrolled 17 healthy persons and performed peripheral nerve diffusion weighted imaging (DWI) and magnetization transfer imaging (MTI) of the sciatic, tibial and fibular nerve. Participants were scanned bilaterally, and findings were divided into ipsilateral and contralateral nerve fibers relative to self-reporting of hand dominance. Generalized estimating equation modeling was used to evaluate nerve fiber differences between ipsilateral and contralateral legs while controlling for confounding variables. All findings controlled for age, sex and number of scans performed. Results A main effect of laterality was found in radial, axial, and mean diffusivity for the tibial nerve. Axial diffusivity was found to be lateralized in the sciatic nerve. When evaluating mean MTR, a main effect of laterality was found for each nerve division. A main effect of sex was found in the tibial and fibular nerve fiber bundles. Conclusion For the evaluation of nerve measures using DWI and MTI, in either healthy or disease states, consideration of underlying biological metrics of laterality in peripheral nerve fiber characteristics need to considered for data analysis. Integrating knowledge regarding biological laterality of peripheral nerve microstructure may be applied to improve how we diagnosis pain disorders, how we track patients’ recovery and how we forecast pain chronification.
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Affiliation(s)
- Scott A. Holmes
- Center for Pain and the Brain, Boston Children’s Hospital, Boston, Massachusetts, United States of America
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States of America
- * E-mail:
| | - Steven J. Staffa
- Center for Pain and the Brain, Boston Children’s Hospital, Boston, Massachusetts, United States of America
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | - Anastasia Karapanagou
- Center for Pain and the Brain, Boston Children’s Hospital, Boston, Massachusetts, United States of America
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | - Natalia Lopez
- Center for Pain and the Brain, Boston Children’s Hospital, Boston, Massachusetts, United States of America
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | - Victoria Karian
- Center for Pain and the Brain, Boston Children’s Hospital, Boston, Massachusetts, United States of America
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | - Ronald Borra
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - David Zurakowski
- Center for Pain and the Brain, Boston Children’s Hospital, Boston, Massachusetts, United States of America
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | - Alyssa Lebel
- Center for Pain and the Brain, Boston Children’s Hospital, Boston, Massachusetts, United States of America
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | - David Borsook
- Center for Pain and the Brain, Boston Children’s Hospital, Boston, Massachusetts, United States of America
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States of America
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5
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Caruso A, Grolnick W, Mueller C, Kaczynski K, Chang CYH, Lebel A. Health Mindsets in Pediatric Chronic Headache. J Pediatr Psychol 2021; 47:391-402. [PMID: 34877604 DOI: 10.1093/jpepsy/jsab115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 10/12/2021] [Accepted: 10/12/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Given how frequently youth with chronic headache and migraine experience setbacks in treatment, identifying factors that promote coping and resilience is critical. Mindsets have gained attention as predictors of behavior and targets of intervention across contexts, including health. Health mindsets may help to explain how children with chronic pain interpret and respond to treatment. This study evaluated whether growth health mindsets might relate to adaptive outcomes in patients with chronic pediatric headache. METHODS Participants were 88 children and adolescents (ages 10-17 years) with headache or migraine contacted following an appointment at a pediatric headache clinic, and their parent. Patients rated their beliefs about health as more fixed versus growth-oriented. They were presented with vignettes depicting hypothetical treatment setbacks and instructed to reflect upon real-life setbacks. Patients completed questionnaires about their cognitive appraisals of setbacks, coping, quality of life, life satisfaction, and functional impairment. RESULTS The higher children rated their growth health mindsets, the less likely they were to appraise setbacks as threatening and endorse quality-of-life problems. Children with higher growth mindsets reported higher life satisfaction and lower functional disability. There was also an indirect relation between children's mindsets and coping through cognitive appraisals of setbacks as a threat, but not challenge. CONCLUSION This research extends the health mindsets literature by contributing preliminary evidence of health mindsets as tied to adaptive outcomes in youth with chronic headache. These findings may be of interest to clinicians and parents, as health mindsets may offer an avenue by which resilience is promoted and maladaptive appraisals are minimized.
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Affiliation(s)
- Alessandra Caruso
- Department of Psychology, Clark University, USA.,Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, USA
| | | | - Claudia Mueller
- Department of Surgery, Stanford University School of Medicine, USA
| | - Karen Kaczynski
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, USA.,Department of Psychiatry, Harvard Medical School, USA
| | - Cindy Yu-Hsing Chang
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, USA
| | - Alyssa Lebel
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, USA.,Department of Neurology, Harvard Medical School, USA
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6
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Holmes SA, Karapanagou A, Staffa SJ, Zurakowski D, Borra R, Simons LE, Sieberg C, Lebel A, Borsook D. DTI and MTR Measures of Nerve Fiber Integrity in Pediatric Patients With Ankle Injury. Front Pediatr 2021; 9:656843. [PMID: 34660471 PMCID: PMC8511521 DOI: 10.3389/fped.2021.656843] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 08/18/2021] [Indexed: 11/13/2022] Open
Abstract
Acute peripheral nerve injury can lead to chronic neuropathic pain. Having a standardized, non-invasive method to evaluate pathological changes in a nerve following nerve injury would help with diagnostic and therapeutic assessments or interventions. The accurate evaluation of nerve fiber integrity after injury may provide insight into the extent of pathology and a patient's level of self-reported pain. The aim of this investigation was to evaluate the extent to which peripheral nerve integrity could be evaluated in an acute ankle injury cohort and how markers of nerve fiber integrity correlate with self-reported pain levels in afferent nerves. We recruited 39 pediatric participants with clinically defined neuropathic pain within 3 months of an ankle injury and 16 healthy controls. Participants underwent peripheral nerve MRI using diffusion tensor (DTI) and magnetization transfer imaging (MTI) of their injured and non-injured ankles. The imaging window was focused on the branching point of the sciatic nerve into the tibial and fibular division. Each participant completed the Pain Detection Questionnaire (PDQ). Findings demonstrated group differences in DTI and MTI in the sciatic, tibial and fibular nerve in the injured ankle relative to healthy control and contralateral non-injured nerve fibers. Only AD and RD from the injured fibular nerve correlated with PDQ scores which coincides with the inversion-dominant nature of this particular ankle injuruy cohort. Exploratory analyses highlight the potential remodeling stages of nerve injury from neuropathic pain. Future research should emphasize sub-acute time frames of injury to capture post-injury inflammation and nerve fiber recovery.
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Affiliation(s)
- Scott A. Holmes
- Center for Pain and the Brain, Boston Children's Hospital, Boston, MA, United States
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States
| | - Anastasia Karapanagou
- Center for Pain and the Brain, Boston Children's Hospital, Boston, MA, United States
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States
| | - Steven J. Staffa
- Center for Pain and the Brain, Boston Children's Hospital, Boston, MA, United States
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States
| | - David Zurakowski
- Center for Pain and the Brain, Boston Children's Hospital, Boston, MA, United States
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States
| | - Ronald Borra
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Laura E. Simons
- Department of Anesthesia, Stanford University, Stanford, CA, United States
| | - Christine Sieberg
- Center for Pain and the Brain, Boston Children's Hospital, Boston, MA, United States
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States
| | - Alyssa Lebel
- Center for Pain and the Brain, Boston Children's Hospital, Boston, MA, United States
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States
| | - David Borsook
- Center for Pain and the Brain, Boston Children's Hospital, Boston, MA, United States
- Departments of Psychiatry and Radiology, Massachusetts General Hospital, Boston, MA, United States
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7
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Sieberg CB, Lebel A, Silliman E, Holmes S, Borsook D, Elman I. Left to themselves: Time to target chronic pain in childhood rare diseases. Neurosci Biobehav Rev 2021; 126:276-288. [PMID: 33774086 PMCID: PMC8738995 DOI: 10.1016/j.neubiorev.2021.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/02/2021] [Accepted: 03/04/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Chronic pain is prevalent among patients with rare diseases (RDs). However, little is understood about how biopsychosocial mechanisms may be integrated in the unique set of clinical features and therapeutic challenges inherent in their pain conditions. METHODS This review presents examples of major categories of RDs with particular pain conditions. In addition, we provide translational evidence on clinical and scientific rationale for psychosocially- and neurodevelopmentally-informed treatment of pain in RD patients. RESULTS Neurobiological and functional overlap between various RD syndromes and pain states suggests amalgamation and mutual modulation of the respective conditions. Emotional sequelae could be construed as an emotional homologue of physical pain mediated via overlapping brain circuitry. Given their clearly defined genetic and molecular etiologies, RDs may serve as heuristic models for unraveling pathophysiological processes inherent in chronic pain. CONCLUSIONS Systematic evaluation of chronic pain in patients with RD contributes to sophisticated insight into both pain and their psychosocial correlates, which could transform treatment.
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Affiliation(s)
- Christine B Sieberg
- Biobehavioral Pediatric Pain Lab, Department of Psychiatry & Behavioral Sciences, Boston Children's Hospital, Boston, MA, 02115, USA; Center for Pain and the Brain (P.A.I.N Group), Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital, Boston, MA 02115, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
| | - Alyssa Lebel
- Center for Pain and the Brain (P.A.I.N Group), Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital, Boston, MA 02115, USA; Department of Anesthesiology, Harvard Medical School, Boston, MA, 02115, USA
| | - Erin Silliman
- Biobehavioral Pediatric Pain Lab, Department of Psychiatry & Behavioral Sciences, Boston Children's Hospital, Boston, MA, 02115, USA; Division of Graduate Medical Sciences, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Scott Holmes
- Center for Pain and the Brain (P.A.I.N Group), Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital, Boston, MA 02115, USA; Department of Anesthesiology, Harvard Medical School, Boston, MA, 02115, USA
| | - David Borsook
- Center for Pain and the Brain (P.A.I.N Group), Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital, Boston, MA 02115, USA; Department of Anesthesiology, Harvard Medical School, Boston, MA, 02115, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA.
| | - Igor Elman
- Center for Pain and the Brain (P.A.I.N Group), Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital, Boston, MA 02115, USA; Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, 02139, USA
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8
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Shapiro HF, Lebel A. Pediatric Episodic Migraine with Aura: A Unique Entity? Children (Basel) 2021; 8:children8030228. [PMID: 33802676 PMCID: PMC8002456 DOI: 10.3390/children8030228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/13/2021] [Accepted: 03/15/2021] [Indexed: 11/16/2022]
Abstract
Migraine headache is a common cause of pain and disability in children and adolescents and is a major contributor to frequently missed school days and limitations in activities. Of children and adolescents with migraine headache, approximately one-third have migraine with aura (MA). MA is often considered to be similar to migraine without aura (MO), and thus, many studies do not stratify patients based on the presence of aura. Because of this, treatment recommendations are often analogous between MA and MO, with a few notable exceptions. The purpose of this review is to highlight the current evidence demonstrating the unique pathophysiology, clinical characteristics, differential diagnosis, co-morbidities, and treatment recommendations and responses for pediatric MA.
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Affiliation(s)
- Hannah F.J. Shapiro
- Department of Child Neurology, Boston Children’s Hospital, Boston, MA 02115, USA;
| | - Alyssa Lebel
- Division of Pain Medicine, Department of Anesthesiology, Boston Children’s Hospital, Boston, MA 02115, USA
- Correspondence:
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9
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Youssef AM, Peng K, Kim PK, Lebel A, Sethna NF, Kronman C, Zurakowski D, Borsook D, Simons LE. Pain stickiness in pediatric complex regional pain syndrome: A role for the nucleus accumbens. Neurobiol Pain 2021; 9:100062. [PMID: 33732954 PMCID: PMC7941018 DOI: 10.1016/j.ynpai.2021.100062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 02/08/2021] [Accepted: 02/12/2021] [Indexed: 11/16/2022]
Abstract
Pain nonresponders have decreased nucleus accumbens (NAc) grey matter density. Pain nonresponders have reduced functional connectivity between NAc and dlPFC. Connectivity strength between NAc and dlPFC correlates with changes in pain. Prediction estimate for pain improvement with grey matter and connectivity was 87%.
Some individuals with chronic pain experience improvement in their pain with treatment, whereas others do not. The neurobiological reason is unclear, but an understanding of brain structure and functional patterns may provide insights into pain’s responsivity to treatment. In this investigation, we used magnetic resonance imaging (MRI) techniques to determine grey matter density alterations on resting functional connectivity (RFC) strengths between pain responders and nonresponders in patients with complex regional pain syndrome. Brain metrics of pediatric patients at admission to an intensive pain rehabilitative treatment program were evaluated. Pain responders reported significant pain improvement at discharge and/or follow-up whereas nonresponders reported no improvements in pain, increases in pain, or emergence of new pain symptoms. The pain (responder/nonresponder) groups were compared with pain-free healthy controls to examine predictors of pain responder status via brain metrics. Our results show: (1) on admission, pain nonresponders had decreased grey matter density (GMD) within the nucleus accumbens (NAc) and reduced RFC strength between the NAc and the dorsolateral prefrontal cortex vs. responders; (2) Connectivity strength was positively correlated with change in pain intensity from admission to discharge; (3) Compared with pain-free controls, grey matter and RFC differences emerged only among pain nonresponders; and (4) Using a discriminative model, combining GMD and RFC strengths assessed at admission showed the highest prediction estimate (87%) on potential for pain improvement, warranting testing in a de novo sample. Taken together, these results support the idea that treatment responsiveness on pain is underpinned by concurrent brain structure and resting brain activity.
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Affiliation(s)
- Andrew M Youssef
- Center for Pain and the Brain, Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital, Boston, MA 02115, United States.,Department of Anaesthesia, Harvard Medical School, Boston, MA 02115, United States
| | - Ke Peng
- Center for Pain and the Brain, Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital, Boston, MA 02115, United States.,Department of Anaesthesia, Harvard Medical School, Boston, MA 02115, United States.,Department of Radiology and Psychiatry, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Pearl Kijoo Kim
- Center for Pain and the Brain, Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital, Boston, MA 02115, United States
| | - Alyssa Lebel
- Center for Pain and the Brain, Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital, Boston, MA 02115, United States.,Department of Anaesthesia, Harvard Medical School, Boston, MA 02115, United States
| | - Navil F Sethna
- Center for Pain and the Brain, Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital, Boston, MA 02115, United States.,Department of Anaesthesia, Harvard Medical School, Boston, MA 02115, United States
| | - Corey Kronman
- Department of Anesthesiology, Perioperative & Pain Medicine, Stanford University School of Medicine, Stanford, CA 94305, United States
| | - David Zurakowski
- Center for Pain and the Brain, Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital, Boston, MA 02115, United States.,Department of Anaesthesia, Harvard Medical School, Boston, MA 02115, United States
| | - David Borsook
- Center for Pain and the Brain, Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital, Boston, MA 02115, United States.,Department of Anaesthesia, Harvard Medical School, Boston, MA 02115, United States.,Department of Radiology and Psychiatry, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Laura E Simons
- Department of Anesthesiology, Perioperative & Pain Medicine, Stanford University School of Medicine, Stanford, CA 94305, United States
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10
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Lemme J, Holmes S, Sibai D, Mari J, Simons LE, Burstein R, Zurakowski D, Lebel A, O'Brien M, Upadhyay J, Borsook D. Altered Brain Network Connectivity Underlies Persistent Post-Traumatic Headache following Mild Traumatic Brain Injury in Youth. J Neurotrauma 2021; 38:1632-1641. [PMID: 33183144 DOI: 10.1089/neu.2020.7189] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Post-traumatic headaches (PTHs) are associated with mild traumatic brain injuries (mTBI) and may predict the persistence of concussion symptoms. Altered brain networks implicated in brain injury and the affective components of headache-related pain may underlie the resolution of PTH. This is a hypothesis-generating investigation to evaluate the extent to which pain symptom reporting and functional brain changes are different in a cohort of young mTBI patients with resolved (PTH-R) and persistent (PTH-P) post-traumatic headache symptoms relative to healthy controls. This was a cross-sectional investigation involving 59 participants between the ages of 12-24 (PTH-P, n = 21; PTH-R, n = 18; healthy control, n = 20). Participants had no significant history of pre-existing headaches, chronic pain, or psychiatric neurological conditions. The primary outcome was resting-state functional connectivity (RS-Fc) alterations between cohorts. Secondary outcomes were self-reported pain-related symptoms. Elevated scores were reported for fear of pain in both PTH cohorts. Using a false discovery rate of p = 0.05, the PTH-P cohort showed altered connectivity relative to healthy controls in brain regions such as the frontal, temporal, and cerebellar regions, as well as sub-cortical regions including the amygdala and accumbens. The PTH-R cohort showed altered RS-Fc between cerebellar and temporal lobe sub-regions. Our results indicate that a core network of brain regions implicated in the affective pain response are functionally altered in PTH cohorts. Results should be interpreted given limitations on sample size and multiple comparisons. Despite the resolution of symptoms, persons who experience PTH may experience ongoing functional brain abnormalities, which may underlie symptom chronification.
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Affiliation(s)
- Jordan Lemme
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital-Harvard Medical School, Boston, Massachusetts, USA
| | - Scott Holmes
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital-Harvard Medical School, Boston, Massachusetts, USA
| | - Diana Sibai
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital-Harvard Medical School, Boston, Massachusetts, USA
| | - Joud Mari
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital-Harvard Medical School, Boston, Massachusetts, USA
| | - Laura E Simons
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Rami Burstein
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - David Zurakowski
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital-Harvard Medical School, Boston, Massachusetts, USA
| | - Alyssa Lebel
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital-Harvard Medical School, Boston, Massachusetts, USA
| | - Michael O'Brien
- Department of Orthopedic Surgery, Boston Children's Hospital-Harvard Medical School, Boston, Massachusetts, USA
| | - Jaymin Upadhyay
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital-Harvard Medical School, Boston, Massachusetts, USA
| | - David Borsook
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital-Harvard Medical School, Boston, Massachusetts, USA
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11
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Clementi MA, Chang YH, Gambhir R, Lebel A, Logan DE. The Impact of Sleep on Disability and School Functioning: Results From a Tertiary Pediatric Headache Center. J Child Neurol 2020; 35:221-227. [PMID: 31726920 DOI: 10.1177/0883073819887597] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Pediatric headache patients often experience significant sleep disturbance, which may be a risk factor for poor physical, academic, and emotional functioning, including increased anxiety/fear. The current retrospective cohort study of a clinical sample of youth with persistent headache aimed to examine the impact of sleep on functional outcomes and to explore pain-related fear as a mediator of the association between sleep problems and functioning. A total of 109 youth (aged 7-17 years) with persistent headache presenting to a tertiary pediatric headache center (and their parents) completed measures of sleep problems, fear of pain, functional disability, and school functioning at the time of an initial evaluation and 6 months later. After controlling for age and headache frequency and severity, linear regression analyses indicated that increased sleep problems at baseline were associated with increased functional disability and poorer school functioning at baseline (β = 0.28, P = .01; β = -0.42, P < .001, respectively). Poor sleep at baseline was associated with poorer school functioning (but not functional disability) at follow-up (β = -0.25, P = .02). Mediation models demonstrated an indirect mediating effect of pain-related fear on the association between baseline sleep problems and follow-up functional disability (β = 0.06, 95% confidence interval 0.01, 0.15) and between baseline sleep problems and follow-up school functioning (β = -0.06, 95% confidence interval -0.13, -0.004). Sleep disturbance in youth with headache may be a risk factor for poor functional outcomes, both concurrently and over time, and may be explained partially through pain-related fear. Given the frequency with which pediatric headache patients experience co-occurring sleep problems, sleep should be thoroughly assessed and considered as a potential early treatment target.
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Affiliation(s)
- Michelle A Clementi
- Department of Anesthesiology, Division of Pain Medicine, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA, USA.,Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Yu-Hsing Chang
- Department of Anesthesiology, Division of Pain Medicine, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Rupa Gambhir
- Department of Anesthesiology, Division of Pain Medicine, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA, USA.,Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Alyssa Lebel
- Department of Anesthesiology, Division of Pain Medicine, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA, USA.,Department of Neurology, Boston Children's Hospital, Boston, MA, USA
| | - Deirdre E Logan
- Department of Anesthesiology, Division of Pain Medicine, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA, USA.,Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
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12
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Holmes S, Barakat N, Bhasin M, Lopez N, Lebel A, Zurakowski D, Thomas B, Bhasin S, Silva K, Borra R, Burstein R, Simons L, Borsook D. Biological and behavioral markers of pain following nerve injury in humans. Neurobiol Pain 2020; 7:100038. [PMID: 31890990 PMCID: PMC6926375 DOI: 10.1016/j.ynpai.2019.100038] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 11/12/2019] [Accepted: 11/19/2019] [Indexed: 12/18/2022]
Abstract
The evolution of peripheral and central changes following a peripheral nerve injury imply the onset of afferent signals that affect the brain. Changes to inflammatory processes may contribute to peripheral and central alterations such as altered psychological state and are not well characterized in humans. We focused on four elements that change peripheral and central nervous systems following ankle injury in 24 adolescent patients and 12 age-sex matched controls. Findings include (a) Changes in tibial, fibular, and sciatic nerve divisions consistent with neurodegeneration; (b) Changes within the primary motor and somatosensory areas as well as higher order brain regions implicated in pain processing; (c) Increased expression of fear of pain and pain reporting; and (d) Significant changes in cytokine profiles relating to neuroinflammatory signaling pathways. Findings address how changes resulting from peripheral nerve injury may develop into chronic neuropathic pain through changes in the peripheral and central nervous system.
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Affiliation(s)
- S.A. Holmes
- Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children’s Hospital, Boston, MA 02215, United States
- Department of Anesthesia, Harvard Medical School, Boston, MA 02115, United States
| | - N. Barakat
- Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children’s Hospital, Boston, MA 02215, United States
- Department of Anesthesia, Harvard Medical School, Boston, MA 02115, United States
| | - M. Bhasin
- Bioinformatic and Systems Biology Center, Beth Israel Deaconess Medical Center, United States
- Department of Medicine, Harvard Medical School, United States
| | - N.I. Lopez
- Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children’s Hospital, Boston, MA 02215, United States
| | - A. Lebel
- Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children’s Hospital, Boston, MA 02215, United States
- Department of Anesthesia, Harvard Medical School, Boston, MA 02115, United States
| | - D. Zurakowski
- Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children’s Hospital, Boston, MA 02215, United States
| | - B. Thomas
- Bioinformatic and Systems Biology Center, Beth Israel Deaconess Medical Center, United States
- Department of Medicine, Harvard Medical School, United States
| | - S. Bhasin
- Bioinformatic and Systems Biology Center, Beth Israel Deaconess Medical Center, United States
- Department of Medicine, Harvard Medical School, United States
| | - K.E. Silva
- Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children’s Hospital, Boston, MA 02215, United States
| | - R. Borra
- Department of Radiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, Netherlands
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, Netherlands
| | - R. Burstein
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, United States
| | - L.E. Simons
- Department of Anesthesiology, Perioperative & Pain Medicine, Stanford University School of Medicine, Stanford, CA 94305, United States
| | - D. Borsook
- Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children’s Hospital, Boston, MA 02215, United States
- Department of Anesthesia, Harvard Medical School, Boston, MA 02115, United States
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13
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Caruso A, Grolnick W, Rabner J, Lebel A. Parenting, self-regulation, and treatment adherence in pediatric chronic headache: A self-determination theory perspective. J Health Psychol 2019; 26:1637-1650. [PMID: 31674212 DOI: 10.1177/1359105319884596] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study examined parenting factors associated with children's self-regulation and physician-rated treatment adherence using a self-determination theory framework in pediatric chronic headache. Participants were 58 children and adolescents (aged 10-17 years), who underwent initial and follow-up multidisciplinary evaluation at a headache clinic, and their mothers. Regression analyses showed that higher maternal autonomy support and structure were significantly related to children's lower treatment-related reactance and higher adherence. Maternal controllingness had associations in the opposite directions. Children's fear of pain was related to maternal controllingness. Results suggest the importance of parents' provision of clear expectations and engaging children in treatment problem-solving and decision-making.
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14
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Lebel A, Auclair A, Pettigrew M, Thibault M, Ménard-Cholette V, Poirier P, Marceau S, Biertho L. IS THE 6 MINUTE WALK TEST A MAXIMAL TEST IN SEVERE OBESITY: COMPARISON WITH THE CARDIOPULMONARY EXERCISE TEST, THE VO2 MAX? Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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15
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Kaczynski K, Rabner J, Farrell M, Karian V, Chang C, Lebel A. Pediatric Headache and Sleep Disturbance: A Comparison of Diagnostic Groups – A Response. Headache 2019; 59:1387-1388. [DOI: 10.1111/head.13631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Karen Kaczynski
- Department of Anesthesiology, Perioperative and Pain Medicine Children's Hospital Boston Boston MA USA
| | | | - Mikayla Farrell
- Department of Anesthesiology, Perioperative and Pain Medicine Children's Hospital Boston Boston MA USA
| | - Victoria Karian
- Department of Anesthesiology, Perioperative and Pain Medicine Children's Hospital Boston Boston MA USA
| | - Cindy Chang
- Department of Anesthesiology, Perioperative and Pain Medicine Children's Hospital Boston Boston MA USA
| | - Alyssa Lebel
- Department of Anesthesiology, Perioperative and Pain Medicine Children's Hospital Boston Boston MA USA
- Department of Neurology, Perioperative and Pain Medicine Children's Hospital Boston Boston MA USA
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16
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Youssef AM, Azqueta-Gavaldon M, Silva KE, Barakat N, Lopez N, Mahmud F, Lebel A, Sethna NF, Zurakowski D, Simons LE, Kraft E, Borsook D. Shifting brain circuits in pain chronicity. Hum Brain Mapp 2019; 40:4381-4396. [PMID: 31298464 DOI: 10.1002/hbm.24709] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 06/04/2019] [Accepted: 06/11/2019] [Indexed: 11/10/2022] Open
Abstract
The evaluation of brain changes to a specific pain condition in pediatric and adult patients allows for insights into potential mechanisms of pain chronicity and possibly long-term brain changes. Here we focused on the primary somatosensory system (SS) involved in pain processing, namely the ventroposterolateral thalamus (VPL) and the primary somatosensory cortex (SI). We evaluated, using MRI, three specific processes: (a) somatotopy of changes in the SS for different pain origins (viz., foot vs. arm); (b) differences in acute (ankle sprain versus complex regional pain syndrome-CRPS); and (c) differences of the effects of CRPS on SS in pediatric versus adult patients. In all cases, age- and sex-matched individuals were used as controls. Our results suggest a shift in concurrent gray matter density (GMD) and resting functional connectivity strengths (rFC) across pediatric and adult CRPS with (a) differential patterns of GMD (VPL) and rFC (SI) on SS in pediatric vs. adult patterns that are consistent with upper and lower limb somatotopical organization; and (b) widespread GMD alterations in pediatric CRPS from sensory, emotional and descending modulatory processes to more confined sensory-emotional changes in adult CRPS and rFC patterns from sensory-sensory alterations in pediatric populations to a sensory-emotional change in adult populations. These results support the idea that pediatric and adult CRPS are differentially represented and may reflect underlying differences in pain chronification across age groups that may contribute to the well-known differences between child and adult pain vulnerability and resilience.
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Affiliation(s)
- Andrew M Youssef
- Center for Pain and the Brain, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.,Department of Anesthesia, Harvard Medical School, Boston, Massachusetts
| | - Monica Azqueta-Gavaldon
- Department of Orthopedics, Physical Medicine and Rehabilitation, Medical Centre of University of Munich, Munich, Germany.,Interdisciplinary Pain Unit, Medical Centre of University of Munich, Munich, Germany
| | - Katie E Silva
- Center for Pain and the Brain, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.,Department of Anesthesia, Harvard Medical School, Boston, Massachusetts
| | - Nadia Barakat
- Center for Pain and the Brain, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.,Department of Anesthesia, Harvard Medical School, Boston, Massachusetts
| | - Natalia Lopez
- Center for Pain and the Brain, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.,Department of Anesthesia, Harvard Medical School, Boston, Massachusetts
| | - Farah Mahmud
- Center for Pain and the Brain, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.,Department of Anesthesia, Harvard Medical School, Boston, Massachusetts
| | - Alyssa Lebel
- Center for Pain and the Brain, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.,Department of Anesthesia, Harvard Medical School, Boston, Massachusetts
| | - Navil F Sethna
- Center for Pain and the Brain, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.,Department of Anesthesia, Harvard Medical School, Boston, Massachusetts
| | - David Zurakowski
- Center for Pain and the Brain, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.,Department of Anesthesia, Harvard Medical School, Boston, Massachusetts
| | - Laura E Simons
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Eduard Kraft
- Department of Orthopedics, Physical Medicine and Rehabilitation, Medical Centre of University of Munich, Munich, Germany.,Interdisciplinary Pain Unit, Medical Centre of University of Munich, Munich, Germany
| | - David Borsook
- Center for Pain and the Brain, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.,Department of Anesthesia, Harvard Medical School, Boston, Massachusetts
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17
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Lopez NI, Holmes S, Barakat N, Lebel A, Simons L, Borsook D. Isolating Brain Regions Implicated in the Affective Components of Neuropathic Pain. Can J Pain 2019. [DOI: 10.1080/24740527.2019.1591828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Natalia I. Lopez
- Anesthesiology, Perioperative & Pain Medicine, Boston Children’s Hospital, Boston, MA, USA
| | - Scott Holmes
- Anesthesiology, Perioperative & Pain Medicine, Boston Children’s Hospital, Boston, MA, USA
| | - Nadia Barakat
- Anesthesiology, Perioperative & Pain Medicine, Boston Children’s Hospital, Boston, MA, USA
| | - Alyssa Lebel
- Anesthesiology, Perioperative & Pain Medicine, Boston Children’s Hospital, Boston, MA, USA
| | - Laura Simons
- Anesthesiology, Perioperative & Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - David Borsook
- Anesthesiology, Perioperative & Pain Medicine, Boston Children’s Hospital, Boston, MA, USA
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18
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Delaney AC, Velarde A, Harper MB, Lebel A, Landschaft A, Monuteaux M, Heidary G, Kimia AA. Predictors of Primary Intracranial Hypertension in Children Using a Newly Suggested Opening Pressure Cutoff of 280 mm H 2O. Pediatr Neurol 2019; 91:27-33. [PMID: 30573329 DOI: 10.1016/j.pediatrneurol.2018.09.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 09/19/2018] [Accepted: 09/26/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES We assessed the clinical characteristics of primary intracranial hypertension (PIH) in children using a newly recommended threshold for cerebrospinal fluid opening pressure (280 mm H2O). METHOD Cross-sectional study of patients age ≤21 years who had a lumbar puncture done for evaluation of PIH. Patients were excluded if lumbar puncture was done for a suspected infection, seizure, mental status changes, multiple sclerosis, or Guillain-Barre syndrome. Cases were identified using a text-search module followed by manual review. We performed χ2 analysis for categorical data and Mann-Whitney U test for continuous data, followed by a binary logistic regression. RESULTS We identified 374 patients of whom 67% were female, median age was 13 years interquartile range (11 to 16 years), and admission rate was 24%. Using an opening pressure cutoff of 250 mm H2O, 127 patients (34%) were identified as having PIH, whereas using the new cutoff 105 patients (28%) met PIH criteria. Predictors for PIH included optic disc edema or sixth nerve palsy using both old, odds ratio (OR) 7.6 (4.3, 13.5), and new cutoffs, OR 9.7 (95% confidence interval 5.1, 18.5). Headache duration ≤61 days is predictive of PIH using the new cutoff OR 4.1 (95% confidence interval 1.3, 12.8). A model is presented which stratifies patients into groups with low (7%), medium (18%), and high (greater than 42%) risk of PIH. CONCLUSIONS A higher cerebrospinal fluid opening pressure threshold in the criteria of PIH is associated with PIH patients with a different symptom profile. Children with optic disc edema, bulging fontanel or sixth nerve palsy, are at increased risk for PIH.
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Affiliation(s)
- Atima C Delaney
- Department of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Aynslee Velarde
- Department of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Marvin B Harper
- Department of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Alyssa Lebel
- Department of Anesthesia/Neurology, Boston Children's Hospital, Boston, Massachusetts
| | - Assaf Landschaft
- Department of IT, Boston Children's Hospital, Boston, Massachusetts
| | - Michael Monuteaux
- Department of Biostat, Boston Children's Hospital, Boston, Massachusetts
| | - Gena Heidary
- Department of Neuro-Ophthalmology, Boston Children's Hospital, Boston, Massachusetts
| | - Amir A Kimia
- Department of Emergency Medicine, Department of Informatics, Boston Children's Hospital, Boston, Massachusetts.
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19
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Belhadj M, Kempf E, Lebel A, Guillemin A, Boussion H, Joly C, Baumgaertner I, Assaf E, Saldana C, Rousseau BC, Tournigand C. How to monitor outpatients undergoing active anticancer treatment? A feasibility study of the web-based tool “Onco’nect®”. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy278.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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20
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Heathcote LC, Rabner J, Lebel A, Hernandez JM, Simons LE. Rapid Screening of Risk in Pediatric Headache: Application of the Pediatric Pain Screening Tool. J Pediatr Psychol 2017; 43:243-251. [DOI: 10.1093/jpepsy/jsx123] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 09/19/2017] [Indexed: 02/01/2023] Open
Affiliation(s)
- Lauren C Heathcote
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University
| | - Jonathan Rabner
- Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children’s Hospital
| | - Alyssa Lebel
- Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children’s Hospital
| | - Jessica M Hernandez
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University
| | - Laura E Simons
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University
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21
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Wilcox SL, Ludwick AM, Lebel A, Borsook D. Age- and sex-related differences in the presentation of paediatric migraine: A retrospective cohort study. Cephalalgia 2017; 38:1107-1118. [PMID: 28766966 DOI: 10.1177/0333102417722570] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Introduction Although migraine is a common headache complaint in children and adolescents there remains a significant gap in understanding the unique aspects of the disease in these age groups and their evolution with development. The aim of this retrospective cohort study was to identify migraine features that are influenced by age and sex. Methods The headache characteristics of 359 paediatric patients with a clinical diagnosis of migraine from a tertiary paediatric headache clinic were assessed. Patients retrospectively reported headache characteristics during a structured intake interview and clinical exam. Headache characteristics, description and associated symptoms were compared between children (age ≤ 12 years) and adolescents (age > 12 years), and between male and female migraineurs. Results Several migraine features differed significantly with age and/or sex, including: (i) a marked change from a 1:1 sex ratio in children to a 2:1 predominance of girls in adolescents; (ii) a higher frequency of headache attacks per month in adolescents and female migraineurs; (iii) a higher proportion of adolescents endorsed a 'throbbing' pain quality; (iv) a higher proportion of children reporting nausea and vomiting; and (v) a higher proportion of adolescents, particularly female migraineurs, had a diagnosis of a co-morbid anxiety. Conclusion The presentation of migraine, both in terms of its headache characteristics and associated symptoms, appear to vary as a function of age and sex. Given that migraine symptoms have a neural basis, it is not surprising that during the key period of neurodevelopment from childhood to adolescence this may impact their presentation.
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Affiliation(s)
- Sophie Louise Wilcox
- 1 Center for Pain and the Brain, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Allison Marra Ludwick
- 1 Center for Pain and the Brain, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alyssa Lebel
- 2 Pediatric Headache Program, Department of Anesthesiology, Perioperative, and Pain Medicine & Department of Neurology, Boston Children's Hospital, Waltham, MA, USA
| | - David Borsook
- 1 Center for Pain and the Brain, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.,2 Pediatric Headache Program, Department of Anesthesiology, Perioperative, and Pain Medicine & Department of Neurology, Boston Children's Hospital, Waltham, MA, USA
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22
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Youssef AM, Ludwick A, Wilcox SL, Lebel A, Peng K, Colon E, Danehy A, Burstein R, Becerra L, Borsook D. In child and adult migraineurs the somatosensory cortex stands out … again: An arterial spin labeling investigation. Hum Brain Mapp 2017; 38:4078-4087. [PMID: 28560777 DOI: 10.1002/hbm.23649] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 04/10/2017] [Accepted: 05/03/2017] [Indexed: 11/06/2022] Open
Abstract
Over the past decade, human brain imaging investigations have reported altered regional cerebral blood flow (rCBF) in the interictal phase of migraine. However, there have been conflicting findings across different investigations, making the use of perfusion imaging in migraine pathophysiology more difficult to define. These inconsistencies may reflect technical constraints with traditional perfusion imaging methods such as single-photon emission computed tomography and positron emission tomography. Comparatively, pseudocontinuous arterial spin labeling (pCASL) is a recently developed magnetic resonance imaging technique that is noninvasive and offers superior spatial resolution and increased sensitivity. Using pCASL, we have previously shown increased rCBF within the primary somatosensory cortex (S1) in adult migraineurs, where blood flow was positively associated with migraine frequency. Whether these observations are present in pediatric and young adult populations remains unknown. This is an important question given the age-related variants of migraine prevalence, symptomology, and treatments. In this investigation, we used pCASL to quantitatively compare and contrast blood flow within S1 in pediatric and young adult migraineurs as compared with healthy controls. In migraine patients, we found significant resting rCBF increases within bilateral S1 as compared with healthy controls. Furthermore, within the right S1, we report a positive correlation between blood flow value with migraine attack frequency and cutaneous allodynia symptom profile. Our results reveal that pediatric and young adult migraineurs exhibit analogous rCBF changes with adult migraineurs, further supporting the possibility that these alterations within S1 are a consequence of repeated migraine attacks. Hum Brain Mapp 38:4078-4087, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Andrew M Youssef
- Center for Pain and the Brain, Department of Anesthesiology, Perioperative & Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.,Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts
| | - Allison Ludwick
- Center for Pain and the Brain, Department of Anesthesiology, Perioperative & Pain Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Sophie L Wilcox
- Center for Pain and the Brain, Department of Anesthesiology, Perioperative & Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.,Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts
| | - Alyssa Lebel
- Center for Pain and the Brain, Department of Anesthesiology, Perioperative & Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.,Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts
| | - Ke Peng
- Center for Pain and the Brain, Department of Anesthesiology, Perioperative & Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.,Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts
| | - Elisabeth Colon
- Center for Pain and the Brain, Department of Anesthesiology, Perioperative & Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.,Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts
| | - Amy Danehy
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts
| | - Rami Burstein
- Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Lino Becerra
- Center for Pain and the Brain, Department of Anesthesiology, Perioperative & Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.,Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts
| | - David Borsook
- Center for Pain and the Brain, Department of Anesthesiology, Perioperative & Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.,Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts
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Kaczynski K, Gambhir R, Caruso A, Lebel A. Depression as a mediator of the relation between family functioning and functional disability in youth with chronic headaches. Headache 2015; 56:491-500. [DOI: 10.1111/head.12709] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Karen Kaczynski
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine; Children's Hospital Boston and Harvard Medical School; Boston MA USA
- Department of Psychiatry; Children's Hospital Boston and Harvard Medical School; Boston MA USA
| | - Rupa Gambhir
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine; Children's Hospital Boston and Harvard Medical School; Boston MA USA
- Department of Psychiatry; Children's Hospital Boston and Harvard Medical School; Boston MA USA
| | - Alessandra Caruso
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine; Children's Hospital Boston and Harvard Medical School; Boston MA USA
| | - Alyssa Lebel
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine; Children's Hospital Boston and Harvard Medical School; Boston MA USA
- Department of Neurology; Children's Hospital Boston and Harvard Medical School; Boston MA USA
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24
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Laé M, Lebel A, Hamel-Viard F, Asselain B, Trassard M, Sastre X, Kirova YM. Can c-myc amplification reliably discriminate postradiation from primary angiosarcoma of the breast? Cancer Radiother 2015; 19:168-74. [PMID: 25863565 DOI: 10.1016/j.canrad.2015.01.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 12/23/2014] [Accepted: 01/14/2015] [Indexed: 02/07/2023]
Abstract
PURPOSE Breast angiosarcomas are rare vascular malignancies that arise secondary to irradiation or de novo as primary tumours. The aim of this study is to know whether c-myc amplification can reliably discriminate these two entities. MATERIEL AND METHODS Forty-seven patients treated for breast angiosarcomas were studied. Thirty-two patients were diagnosed with postradiation angiosarcomas after breast cancer treatment and 15 patients with primary angiosarcomas. Interphase fluorescence in situ hybridization (FISH) was performed by hybridization of probes covering C-MYC (chromosome 8q24.21) and CEP8 on tissue sections. RESULTS Amplification (5- to 20-fold) of the c-myc oncogene was found in all breast radiation-induced angiosarcomas (32 tumours) but in none of the 15 primary angiosarcomas except one (7%). CONCLUSION This study reinforces that there are true pathogenetic differences between the two types of breast angiosarcomas which are morphologically indistinguishable. These data point the pathways preferentially involved in the pathogenesis of post radiation angiosarcomas of the breast and may provide the basis for an additional targeted therapy.
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Affiliation(s)
- M Laé
- Département de biologie des tumeurs, 26, rue d'Ulm, 75005 Paris, France
| | - A Lebel
- Département d'oncologie radiothérapie, 26, rue d'Ulm, 75005 Paris, France
| | - F Hamel-Viard
- Département de biologie des tumeurs, 26, rue d'Ulm, 75005 Paris, France
| | - B Asselain
- Département de biostatistiques, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - M Trassard
- Département de biologie des tumeurs, 26, rue d'Ulm, 75005 Paris, France
| | - X Sastre
- Département de biologie des tumeurs, 26, rue d'Ulm, 75005 Paris, France
| | - Y M Kirova
- Département d'oncologie radiothérapie, 26, rue d'Ulm, 75005 Paris, France.
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25
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Erpelding N, Simons L, Lebel A, Serrano P, Pielech M, Prabhu S, Becerra L, Borsook D. Rapid treatment-induced brain changes in pediatric CRPS. Brain Struct Funct 2014; 221:1095-111. [PMID: 25515312 DOI: 10.1007/s00429-014-0957-8] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 12/03/2014] [Indexed: 11/25/2022]
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.
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Affiliation(s)
- Nathalie Erpelding
- 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.
| | - Laura Simons
- 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
| | - Alyssa Lebel
- 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
| | - Paul Serrano
- P.A.I.N. Group, Boston Children's Hospital, Center for Pain and the Brain, 9 Hope Avenue, Waltham, MA, 02453, USA
| | - Melissa Pielech
- P.A.I.N. Group, Boston Children's Hospital, Center for Pain and the Brain, 9 Hope Avenue, Waltham, MA, 02453, USA
| | - Sanjay Prabhu
- Harvard Medical School, Boston, MA, USA
- Department of Radiology, Boston Children's Hospital, Boston, MA, USA
| | - Lino Becerra
- 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
| | - David Borsook
- 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
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Abstract
BACKGROUND Here we report the prescription patterns by drug type, age, and sex of patients at a large academic pediatric hospital. Because there are few guidelines based on outcome studies in pediatric migraine, physician treatment approaches in children vary. METHODS Using the i2b2 query tool, we determined that over an approximately 4 year period, 4839 patients between the ages of 2 and 17 years were observed at Boston Children's Hospital for migraine with or without aura, 59% women and 41% men. RESULTS The most common medications prescribed to this population were sumatriptan, amitriptyline, topiramate, ondansetron, and cyproheptadine. CONCLUSIONS Our findings support recent data regarding choices of medication in the pediatric population and additionally support current studies and future investigation into controlled trials in the pediatric population.
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Affiliation(s)
- Adriana Johnson
- P.A.I.N. Group, Department of Anesthesia, Boston Children's Hospital, Harvard Medical School, Waltham, Massachusetts; Headache Program, Departments of Anesthesia and Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Jonathan Bickel
- Department of Information Services, Boston Children's Hospital, Boston, Massachusetts; Division of Emergency Medicine, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Alyssa Lebel
- P.A.I.N. Group, Department of Anesthesia, Boston Children's Hospital, Harvard Medical School, Waltham, Massachusetts; Headache Program, Departments of Anesthesia and Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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27
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Kalapurakkel S, Carpino EA, Lebel A, Simons LE. "Pain Can't Stop Me": Examining Pain Self-Efficacy and Acceptance as Resilience Processes Among Youth With Chronic Headache. J Pediatr Psychol 2014; 40:926-33. [PMID: 25324532 DOI: 10.1093/jpepsy/jsu091] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Accepted: 09/22/2014] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To examine pain self-efficacy and pain acceptance in relation to functioning in pediatric patients with chronic headache. METHODS Participants were 209 youth aged 8-17 years who presented for a multidisciplinary pediatric headache clinic evaluation. They completed measures of pain self-efficacy and pain acceptance and a standard battery of clinical measures including indicators of emotional functioning. RESULTS Pain self-efficacy and acceptance were associated with less disability, better school functioning, and fewer depressive symptoms. While taking into account several demographic and pain-related variables, pain self-efficacy had a greater association with less functional disability, while pain acceptance had a greater association with less depressive symptoms and better school functioning. CONCLUSIONS These findings indicate that both resilience processes can serve to positively interact with functioning and symptoms of depression. Ultimately, this study suggests that higher levels of pain self-efficacy and pain acceptance in an individual experiencing pain are associated with more positive outcomes.
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Affiliation(s)
- Sreeja Kalapurakkel
- Harvard College, Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital
| | - Elizabeth A Carpino
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital
| | - Alyssa Lebel
- Harvard College,Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital,Department of Psychiatry, Harvard Medical School, andP.A.I.N. Group, Boston Children's Hospital, Center for Pain and the Brain, Harvard Medical School
| | - Laura E Simons
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Department of Psychiatry, Harvard Medical School, and P.A.I.N. Group, Boston Children's Hospital, Center for Pain and the Brain, Harvard Medical School
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28
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Affiliation(s)
- Vanda Faria
- Center for Pain and the Brain, Boston Children's Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Psychology, Uppsala University, Uppsala, Sweden.
| | - Clas Linnman
- Center for Pain and the Brain, Boston Children's Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Alyssa Lebel
- Center for Pain and the Brain, Boston Children's Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA; Chronic Headache Program, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - David Borsook
- Center for Pain and the Brain, Boston Children's Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA; Chronic Headache Program, Boston Children's Hospital, Harvard Medical School, Boston, MA
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29
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Abstract
OBJECTIVE The current study provides the first measure of pain-related fear for pediatric headache patients. METHODS From a large pediatric headache clinic, a cross-sectional cohort of 206 children and adolescents completed measures of pain-related fear, anxiety sensitivity, catastrophizing, pain acceptance, functional disability, and school functioning. RESULTS The two-factor solution of the Fear of Pain Questionnaire (FOPQ) was confirmed from the originally derived structure with pediatric headache patients. Simultaneously regressing FOPQ subscales fear of pain and activity avoidance on theorized construct validity measures demonstrated that fear of pain was more closely linked with anxiety sensitivity and pain catastrophizing while activity avoidance had a strong negative association with pain acceptance (activity engagement and pain willingness). Pain-related fear was not significantly associated with pain level. After controlling for demographic factors and pain, fear of pain and activity avoidance accounted for an additional 26% of the variance in functional disability and school functioning outcomes, with activity avoidance accounting for much of this relationship. CONCLUSIONS Although typically considered an influential construct among musculoskeletal patients, pain-related fear is also an important factor influencing functioning among pediatric headache patients, with the dimension of activity avoidance particularly salient.
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Affiliation(s)
- Laura E Simons
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, MA, USA Department of Psychiatry, Harvard Medical School, MA, USA
| | - Melissa Pielech
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, MA, USA
| | - Stefanie Cappucci
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, MA, USA
| | - Alyssa Lebel
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, MA, USA
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30
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Borsook D, Erpelding N, Lebel A, Linnman C, Veggeberg R, Grant PE, Buettner C, Becerra L, Burstein R. Sex and the migraine brain. Neurobiol Dis 2014; 68:200-14. [PMID: 24662368 DOI: 10.1016/j.nbd.2014.03.008] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Revised: 03/05/2014] [Accepted: 03/13/2014] [Indexed: 12/31/2022] Open
Abstract
The brain responds differently to environmental and internal signals that relate to the stage of development of neural systems. While genetic and epigenetic factors contribute to a premorbid state, hormonal fluctuations in women may alter the set point of migraine. The cyclic surges of gonadal hormones may directly alter neuronal, glial and astrocyte function throughout the brain. Estrogen is mainly excitatory and progesterone inhibitory on brain neuronal systems. These changes contribute to the allostatic load of the migraine condition that most notably starts at puberty in girls.
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Affiliation(s)
- D Borsook
- Boston Children's Hospital P.A.I.N. Group, Boston Children's Hospital, USA; Massachusestts General Hospital, Boston Children's Hospital, USA; Harvard Medical School, USA.
| | - N Erpelding
- Boston Children's Hospital P.A.I.N. Group, Boston Children's Hospital, USA; Harvard Medical School, USA
| | - A Lebel
- Boston Children's Hospital P.A.I.N. Group, Boston Children's Hospital, USA; Headache Clinic, Boston Children's Hospital, USA; Harvard Medical School, USA
| | - C Linnman
- Boston Children's Hospital P.A.I.N. Group, Boston Children's Hospital, USA; Massachusestts General Hospital, Boston Children's Hospital, USA; Harvard Medical School, USA
| | - R Veggeberg
- Boston Children's Hospital P.A.I.N. Group, Boston Children's Hospital, USA; Harvard Medical School, USA
| | - P E Grant
- Fetal-Neonatal Neuroimaging and Developmental Science Center (FNNDSC), Boston Children's Hospital, USA; Harvard Medical School, USA
| | - C Buettner
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, USA; Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, USA; Harvard Medical School, USA
| | - L Becerra
- Boston Children's Hospital P.A.I.N. Group, Boston Children's Hospital, USA; Massachusestts General Hospital, Boston Children's Hospital, USA; Harvard Medical School, USA
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Carpino E, Segal S, Logan D, Lebel A, Simons LE. The interplay of pain-related self-efficacy and fear on functional outcomes among youth with headache. J Pain 2014; 15:527-34. [PMID: 24462790 DOI: 10.1016/j.jpain.2014.01.493] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 12/17/2013] [Accepted: 01/16/2014] [Indexed: 11/26/2022]
Abstract
UNLABELLED Pain-related self-efficacy and pain-related fear have been proposed as opposing predictors of pain-related functional outcomes in youth with chronic pain. Self-efficacy is a potential resiliency factor that can mitigate the influence that pain-related fear has on outcomes in youth with chronic pain. Drawing from theoretical assertions tested among adults with chronic pain, this study aimed to determine whether pain-related self-efficacy mediates the adverse influence of pain-related fear on functional outcomes in a sample of youth with chronic headache. In a cross-sectional design of 199 youth with headache, self-efficacy was strongly associated with fear, disability, school impairment, and depressive symptoms. Pain intensity and self-efficacy were only modestly related, indicating that level of pain has less influence on one's confidence functioning with pain. Self-efficacy partially mediated relationships between pain-related fear and both functional disability and school functioning but did not mediate the relationship between pain-related fear and depressive symptoms. These results suggest that confidence in the ability to function despite pain and fear avoidance each uniquely contributes to pain-related outcomes in youth with chronic headache. These results further suggest that treatment for chronic headache in youth must focus not only on decreasing pain-related fear but also on enhancing a patient's pain-related self-efficacy. PERSPECTIVE Pain-related self-efficacy is an important resiliency factor impacting the influence of pain-related fear on functional disability and school functioning in youth with headache. Enhancing self-efficacy may be a key mechanism for improving behavioral outcomes. Clinicians can reduce pain-related fear and enhance pain-related self-efficacy through interventions that encourage accomplishment and self-confidence.
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Affiliation(s)
- Elizabeth Carpino
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Sharon Segal
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Deirdre Logan
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts; PAIN Group, Boston Children's Hospital & Harvard Medical School, Boston, Massachusetts
| | - Alyssa Lebel
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts; PAIN Group, Boston Children's Hospital & Harvard Medical School, Boston, Massachusetts
| | - Laura E Simons
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts; PAIN Group, Boston Children's Hospital & Harvard Medical School, Boston, Massachusetts.
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Erpelding N, Sava S, Simons LE, Lebel A, Serrano P, Becerra L, Borsook D. Habenula functional resting-state connectivity in pediatric CRPS. J Neurophysiol 2013; 111:239-47. [PMID: 24155006 DOI: 10.1152/jn.00405.2013] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The habenula (Hb) is a small brain structure located in the posterior end of the medial dorsal thalamus and through medial (MHb) and lateral (LHb) Hb connections, it acts as a conduit of information between forebrain and brainstem structures. The role of the Hb in pain processing is well documented in animals and recently also in acute experimental pain in humans. However, its function remains unknown in chronic pain disorders. Here, we investigated Hb resting-state functional connectivity (rsFC) in patients with complex regional pain syndrome (CRPS) compared with healthy controls. Twelve pediatric patients with unilateral lower-extremity CRPS (9 females; 10-17 yr) and 12 age- and sex-matched healthy controls provided informed consent to participate in the study. In healthy controls, Hb functional connections largely overlapped with previously described anatomical connections in cortical, subcortical, and brainstem structures. Compared with controls, patients exhibited an overall Hb rsFC reduction with the rest of the brain and, specifically, with the anterior midcingulate cortex, dorsolateral prefrontal cortex, supplementary motor cortex, primary motor cortex, and premotor cortex. Our results suggest that Hb rsFC parallels anatomical Hb connections in the healthy state and that overall Hb rsFC is reduced in patients, particularly connections with forebrain areas. Patients' decreased Hb rsFC to brain regions implicated in motor, affective, cognitive, and pain inhibitory/modulatory processes may contribute to their symptomatology.
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Linnman C, Becerra L, Lebel A, Berde C, Grant PE, Borsook D. Transient and persistent pain induced connectivity alterations in pediatric complex regional pain syndrome. PLoS One 2013; 8:e57205. [PMID: 23526938 PMCID: PMC3602432 DOI: 10.1371/journal.pone.0057205] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 01/22/2013] [Indexed: 12/16/2022] Open
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.
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Affiliation(s)
- Clas Linnman
- 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.
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Lebel A, Rohan A, Jabot L, Monnet I, Vinas F, Saakashvili Z, Bassinet L, Housset B, Mangiapan G. Drain péritonéal tunnélisé dans les ascites néoplasiques de mésothéliome. Rev Mal Respir 2013. [DOI: 10.1016/j.rmr.2012.10.317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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35
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Toledo E, Lebel A, Becerra L, Minster A, Linnman C, Maleki N, Dodick DW, Borsook D. The young brain and concussion: imaging as a biomarker for diagnosis and prognosis. Neurosci Biobehav Rev 2012; 36:1510-31. [PMID: 22476089 PMCID: PMC3372677 DOI: 10.1016/j.neubiorev.2012.03.007] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 02/15/2012] [Accepted: 03/21/2012] [Indexed: 01/20/2023]
Abstract
Concussion (mild traumatic brain injury (mTBI)) is a significant pediatric public health concern. Despite increased awareness, a comprehensive understanding of the acute and chronic effects of concussion on central nervous system structure and function remains incomplete. Here we review the definition, epidemiology, and sequelae of concussion within the developing brain, during childhood and adolescence, with current data derived from studies of pathophysiology and neuroimaging. These findings may contribute to a better understanding of the neurological consequences of traumatic brain injuries, which in turn, may lead to the development of brain biomarkers to improve identification, management and prognosis of pediatric patients suffering from concussion.
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Affiliation(s)
- Esteban Toledo
- Center for Pain and the Brain, Children's Hospital Boston, Harvard Medical School, United States
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36
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Shelton L, Pendse G, Maleki N, Moulton EA, Lebel A, Becerra L, Borsook D. Mapping pain activation and connectivity of the human habenula. J Neurophysiol 2012; 107:2633-48. [PMID: 22323632 DOI: 10.1152/jn.00012.2012] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The habenula, located in the posterior thalamus, is implicated in a wide array of functions. Animal anatomical studies have indicated that the structure receives inputs from a number of brain regions (e.g., frontal areas, hypothalamic, basal ganglia) and sends efferent connections predominantly to the brain stem (e.g., periaqueductal gray, raphe, interpeduncular nucleus). The role of the habenula in pain and its anatomical connectivity are well-documented in animals but not in humans. In this study, for the first time, we show how high-field magnetic resonance imaging can be used to detect habenula activation to noxious heat. Functional maps revealed significant, localized, and bilateral habenula responses. During pain processing, functional connectivity analysis demonstrated significant functional correlations between the habenula and the periaqueductal gray and putamen. Probabilistic tractography was used to assess connectivity of afferent (e.g., putamen) and efferent (e.g., periaqueductal gray) pathways previously reported in animals. We believe that this study is the first report of habenula activation by experimental pain in humans. Since the habenula connects forebrain structures with brain stem structures, we suggest that the findings have important implications for understanding sensory and emotional processing in the brain during both acute and chronic pain.
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Affiliation(s)
- L Shelton
- P.a.i.n. Group, Children's Hospital Boston, Waltham, MA 02453, USA
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37
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Berde CB, Walco GA, Krane EJ, Anand KJS, Aranda JV, Craig KD, Dampier CD, Finkel JC, Grabois M, Johnston C, Lantos J, Lebel A, Maxwell LG, McGrath P, Oberlander TF, Schanberg LE, Stevens B, Taddio A, von Baeyer CL, Yaster M, Zempsky WT. Pediatric analgesic clinical trial designs, measures, and extrapolation: report of an FDA scientific workshop. Pediatrics 2012; 129:354-64. [PMID: 22250028 PMCID: PMC9923552 DOI: 10.1542/peds.2010-3591] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Analgesic trials pose unique scientific, ethical, and practical challenges in pediatrics. Participants in a scientific workshop sponsored by the US Food and Drug Administration developed consensus on aspects of pediatric analgesic clinical trial design. The standard parallel-placebo analgesic trial design commonly used for adults has ethical and practical difficulties in pediatrics, due to the likelihood of subjects experiencing pain for extended periods of time. Immediate-rescue designs using opioid-sparing, rather than pain scores, as a primary outcome measure have been successfully used in pediatric analgesic efficacy trials. These designs maintain some of the scientific benefits of blinding, with some ethical and practical advantages over traditional designs. Preferred outcome measures were recommended for each age group. Acute pain trials are feasible for children undergoing surgery. Pharmacodynamic responses to opioids, local anesthetics, acetaminophen, and nonsteroidal antiinflammatory drugs appear substantially mature by age 2 years. There is currently no clear evidence for analgesic efficacy of acetaminophen or nonsteroidal antiinflammatory drugs in neonates or infants younger than 3 months of age. Small sample designs, including cross-over trials and N of 1 trials, for particular pediatric chronic pain conditions and for studies of pain and irritability in pediatric palliative care should be considered. Pediatric analgesic trials can be improved by using innovative study designs and outcome measures specific for children. Multicenter consortia will help to facilitate adequately powered pediatric analgesic trials.
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Affiliation(s)
- Charles B. Berde
- Division of Pain Medicine, Department of Anesthesiology, Perioperative, and Pain Medicine, Children's Hospital, Boston, Boston, Massachusetts;,Harvard Medical School, Boston, Massachusetts;,Address correspondence to Charles Berde, MD, PhD, Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Children’s Hospital, Boston, 333 Longwood Ave, 5th floor, Boston, MA 02115. E-mail:
| | - Gary A. Walco
- Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital, Seattle, Washington;,University of Washington School of Medicine, Seattle, Washington
| | - Elliot J. Krane
- Stanford University School of Medicine, Stanford, California;,Lucile Packard Children's Hospital, Stanford, California
| | - K. J. S. Anand
- Division of Pediatric Critical Care Medicine, Le Bonheur Children's Hospital, Memphis, Tennessee;,University of Tennessee Health Science Center, Memphis, Tennessee
| | - Jacob V. Aranda
- The Children's Hospital of Brooklyn, State University of New York, New York, New York;,Pediatric Pharmacology Research Unit Network, Children's Hospital of Michigan, Detroit, Michigan
| | - Kenneth D. Craig
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Carlton D. Dampier
- Emory University School of Medicine, Atlanta, Georgia;,Atlanta Clinical Translational Science Institute, Atlanta, Georgia
| | - Julia C. Finkel
- Department of Anesthesiology George Washington University, Washington, District of Columbia;,Division of Anesthesiology and Pain Medicine, Children's National Medical Center, Washington, District of Columbia
| | - Martin Grabois
- Baylor College of Medicine, Houston, Texas;,University of Texas Health Science Center-Houston, Houston, Texas
| | | | - John Lantos
- Children's Mercy Bioethics Center, Children's Mercy Hospital, Kansas City, Missouri;,University of Missouri–Kansas City, Kansas City, Missouri
| | - Alyssa Lebel
- Division of Pain Medicine, Department of Anesthesiology, Perioperative, and Pain Medicine, Children's Hospital, Boston, Boston, Massachusetts;,Harvard Medical School, Boston, Massachusetts
| | - Lynne G. Maxwell
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;,Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Patrick McGrath
- IWK Health Centre, Halifax, Nova Scotia, Canada;,Dalhousie University, Halifax, Nova Scotia, Canada
| | - Timothy F. Oberlander
- Division of Developmental Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada;,BC Children's Hospital, Vancouver, British Columbia, Canada
| | | | - Bonnie Stevens
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Anna Taddio
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Carl L. von Baeyer
- Department of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Myron Yaster
- Division of Pediatric Anesthesiology, Department of Anesthesiology and Critical Care Medicine, Children's Medical and Surgical Center, The Johns Hopkins Hospital, Baltimore, Maryland; and
| | - William T. Zempsky
- Division of Pain and Palliative Medicine, Connecticut Children's Medical Center, University of Connecticut School of Medicine, Hartford, Connecticut
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de Mauroy J, Weiss H, Aulisa A, Aulisa L, Brox J, Durmala J, Fusco C, Grivas T, Hermus J, Kotwicki T, Le Blay G, Lebel A, Marcotte L, Negrini S, Neuhaus L, Neuhaus T, Pizzetti P, Revzina L, Torres B, Van Loon P, Vasiliadis E, Villagrasa M, Werkman M, Wernicka M, Wong M, Zaina F. 7th SOSORT consensus paper: conservative treatment of idiopathic & Scheuermann's kyphosis. Scoliosis 2010; 5:9. [PMID: 20509962 PMCID: PMC2890418 DOI: 10.1186/1748-7161-5-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Accepted: 05/30/2010] [Indexed: 11/10/2022]
Abstract
UNLABELLED : Thoracic hyperkyphosis is a frequent problem and can impact greatly on patient's quality of life during adolescence. This condition can be idiopathic or secondary to Scheuermann disease, a disease disturbing vertebral growth. To date, there is no sound scientific data available on the management of this condition. Some studies discuss the effects of bracing, however no guidelines, protocols or indication's of treatment for this condition were found. The aim of this paper was to develop and verify the consensus on managing thoracic hyperkyphosis patients treated with braces and/or physiotherapy. METHODS The Delphi process was utilised in four steps gradually modified according to the results of a set of recommendations: we involved the SOSORT Board twice, then all SOSORT members twice, with a Pre-Meeting Questionnaire (PMQ), and during a Consensus Session at the SOSORT Lyon Meeting with a Meeting Questionnaire (MQ). RESULTS There was an unanimous agreement on the general efficacy of bracing and physiotherapy for this condition. Most experts suggested the use of 4-5 point bracing systems, however there was some controversy with regards to physiotherapeutic aims and modalities. CONCLUSION The SOSORT panel of experts suggest the use of rigid braces and physiotherapy to correct thoracic hyperkyphosis during adolescence. The evaluation of specific braces and physiotherapy techniques has been recommended.
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Affiliation(s)
- Jc de Mauroy
- Clinique du Parc, 155 bd Stalingrad, 69006 Lyon, France.
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Lebel A, Becerra L, Wallin D, Moulton EA, Morris S, Pendse G, Jasciewicz J, Stein M, Aiello-Lammens M, Grant E, Berde C, Borsook D. fMRI reveals distinct CNS processing during symptomatic and recovered complex regional pain syndrome in children. Brain 2008; 131:1854-79. [DOI: 10.1093/brain/awn123] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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40
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Niro J, Sapin V, Constantin JM, Cotte B, Lebel A, Roszyk L, R. Eglizot, Tauveron I, Jacquetin B, Lémery D, Gallot D. Prise en charge d’une hypertriglycéridémie gravidique par plasmaphérèse. ACTA ACUST UNITED AC 2007; 35:1133-5. [DOI: 10.1016/j.gyobfe.2007.08.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2007] [Accepted: 08/02/2007] [Indexed: 12/01/2022]
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Abstract
Colorectal carcinoma during pregnancy is very rare. Prognosis is severe because of the advanced stage due to delay in diagnosis and the aggressiveness of this widespread metastatic disease. We report the case of colon metaststic adenocarcinoma during a twin pregnancy with a good outcome. In the light of epidemiology, pathogeny and immunology, the diagnostic challenge for clinicians is distinguishing pregnancy symptoms from the warning signs of colorectal cancer and, we describe recommended medical and surgical management.
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Affiliation(s)
- G Chêne
- Département de Chirurgie Digestive et Viscérale, Centre Hospitalier de Vichy, boulevard Denière, BP 2757, 03201 Vichy Cedex.
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Da Silva N, Meyer-Monard S, Menot ML, Parrado A, Lebel A, Balitrand N, Fenaux P, Micléa JM, Rousselot P, Degos L, Dombret H, Chomienne C. Functional G-CSF pathways in t(8;21) leukemic cells allow for differentiation induction and degradation of AML1-ETO. Hematol J 2002; 1:316-28. [PMID: 11920209 DOI: 10.1038/sj.thj.6200047] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2000] [Accepted: 05/20/2000] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Efficacy of differentiating agents requires that their specific cellular targets are still expressed and functional in the leukemic cells. One hypothesis to target sensitive cells is to select leukemic clones which harbor disrupted transcription factors. CBFalpha and CBFbeta are core-binding proteins which have been identified as transcription regulators of hematopoietic genes and shown to be altered in numerous leukemias. In M2 AML, the t(8;21) translocation, CBFalpha (AML1) is altered and produced as the AML1-ETO fusion protein. The fusion protein blocks transcription and differentiation mediated by G-CSF. Interestingly, AML1-ETO leukemic cell lines are sensitive to numerous cytokines in vitro and can be induced to differentiate in the presence of G-CSF and PMA. MATERIALS AND METHODS As in the APL differentiation model, primary culture provides a useful tool for therapeutic screening of differentiation inducers, we analysed the in vitro sensitivity of 10 fresh M2 AML t(8;21) leukemic samples to G-CSF and the functionality of G-CSF intracellular pathways. In vitro data were compared with in vivo data from four patients treated with rhG-CSF at the dosage of 5 microg/kg/day i.v. for two to three weeks before the initiation of AML induction chemotherapy and immunophenotypic analysis performed weekly to monitor in vivo differentiation. RESULTS In vitro, an increase in CD34+ cells expressing differentiation antigens (CD11b, CD13 or CD15) was noted along with a decrease of immature CD34+/differentiation antigen negative cells. After two weeks of a daily rhG-CSF administration in vivo, a significant, albeit transient, decrease of blast count was achieved, concomitant with an increase in differentiated leukemic cells suggesting that in vivo differentiation occurs. Fresh t(8;21) leukemic cells possess functional G-CSF signaling pathways as normal activity and kinetics of STAT1 and STAT3 binding was observed. Furthermore, differentiation induction leads to a subsequent degradation of the AML1-ETO oncoprotein. CONCLUSION The data presented here supports the claim that G-CSF can induce in vitro and in vivo differentiation of M2 AML t(8;21) cells.
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MESH Headings
- Antigens, CD/analysis
- Apoptosis
- Blood Cells/metabolism
- Blood Cells/pathology
- Bone Marrow Cells/metabolism
- Bone Marrow Cells/pathology
- Cell Differentiation/drug effects
- Chromosomes, Human, Pair 21/genetics
- Chromosomes, Human, Pair 21/ultrastructure
- Chromosomes, Human, Pair 8/genetics
- Chromosomes, Human, Pair 8/ultrastructure
- Core Binding Factor Alpha 2 Subunit
- DNA-Binding Proteins/metabolism
- Granulocyte Colony-Stimulating Factor/pharmacology
- Humans
- Leukemia, Myeloid, Acute/genetics
- Neoplasm Proteins/metabolism
- Oncogene Proteins, Fusion/metabolism
- RUNX1 Translocation Partner 1 Protein
- Receptors, Granulocyte Colony-Stimulating Factor/drug effects
- Receptors, Granulocyte Colony-Stimulating Factor/physiology
- Recombinant Proteins/pharmacology
- STAT1 Transcription Factor
- STAT3 Transcription Factor
- Signal Transduction/drug effects
- Trans-Activators/metabolism
- Transcription Factors/metabolism
- Translocation, Genetic
- Tretinoin/pharmacology
- Tumor Cells, Cultured/drug effects
- Tumor Cells, Cultured/metabolism
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Affiliation(s)
- N Da Silva
- Laboratoire de Biologie Cellulaire Hématopoïétique (LBCH), INSERM E 00-03, et EA 316 Université Paris 7, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75754 Paris Cedex 10, France.
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Henquell C, Bournazeau JA, Vanlieferinghen P, Grangeot-Keros L, Chambon M, Lebel A, Lemery D, Peigue-Lafeuille H. [The re-emergence in 1997 of rubella infections during pregnancy. 11 cases in Clermont-Ferrand]. Presse Med 1999; 28:777-80. [PMID: 10325931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
OBJECTIVE Describe the clinical and laboratory features of rubella observed during the first semester of pregnancy in 11 patients in 1997. PATIENTS AND METHODS Eleven pregnant women, aged 15-30 years, were referred to the Clermont-Ferrand University Hospital for suspected rubella. Four had had at least 1 prior pregnancy, none had been vaccinated. Rubella serology was obtained for all 11 patients and polymerase chain reaction viral amplification was performed on amniotic fluid in 9 cases. RESULTS The virology laboratory identified 8 cases of primary rubella (2 prior to 12 weeks gestation) and 3 reinfections (1 prior to 12 weeks gestation). Fetal infection was evidenced in I gravida II patient at 17-18 weeks gestation. All pregnancies were continued to term and no case of congenital rubella malformation was observed. However specific IgM assays were performed at birth in 6 of the 11 infants and revealed infection in 3. CONCLUSION These observations indicate that a local epidemic of rubella occurred in the general population. They illustrate the risk of a rubella epidemic in France and the lack of sufficient vaccination of the young adult population, finally they emphasize that current anti-rubella vaccination programs should be promoted.
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Affiliation(s)
- C Henquell
- Laboratoire de Virologie, CHRU de Clermont-Ferrand.
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45
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Smolla N, Lebel A. [Child psychiatric day treatment centers in Quebec for children 0-12 years of age]. Can J Psychiatry 1998; 43:714-21. [PMID: 9773221 DOI: 10.1177/070674379804300706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The review lists the child psychiatry day-care centres in Quebec, evaluates their capacity, and describes them according to the age range for admission, the psychopathologies treated, and the parent involvement required. METHOD The 26 programs selected, which are all associated with a hospital centre, assess and treat children aged 0 to 12 years on a day-care basis. Organization, clinical operation, and research are addressed during a semisupervised interview. RESULTS The average capacity is 18 children (4 to 40), with a total capacity of 454 children. The number of preschool patients can be compared with the number of school patients. Few programs are dedicated to invasive development disorders, and one-third treat behavioural or emotional disorders. The larger capacity programs treat patients of both genders. Most programs are eclectic and encourage but do not require parental involvement. CONCLUSIONS Results take into account different theoretical influences, the controversy about integration criteria and parent involvement, and the specificity of the child psychiatry mission.
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Affiliation(s)
- N Smolla
- Service de recherche, Hôpital Rivière-des-Prairies, Montréal, Québec.
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Frare P, Lebel A. [Utilization of thought stopping in the treatment of obsessive- compulsive disorder in a 9 year old girl]. Can J Psychiatry 1996; 41:367-70. [PMID: 8983816 DOI: 10.1177/070674379604100607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To use a pharmacobehavioural approach employing modified techniques of exposure, prevention of the response, and thought stopping in the treatment of obsessive-compulsive disorder in a 9-year-old girl. METHODS The diagnosis of obsessive-compulsive disorder (OCD) was made based on the DSM-IV criteria. The patient was seen over 15 sessions, during which clomipramine was introduced and modified techniques of exposure, prevention of the response, and thought stopping were successively used. Follow-up extended over more than 18 months after the end of the therapy. RESULTS The patient learned and used the behavioural techniques easily, and we observed a rapid, complete, and sustained disappearance of the obsessive-compulsive symptomatology. CONCLUSIONS Use of a pharmacobehavioural approach in treating OCD in young children remains limited. Techniques used with adults and slightly modified to adapt them for children are, in our view, an avenue of treatment worth exploring.
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Affiliation(s)
- P Frare
- Hôpital Notre-Dame, Département de psychiatrie, Montréal, Québec
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Beachley MC, Lebel A, Lankau CA, Rothman D, Baldi A. Carcinoma of the small intestine in chronic regional enteritis. Am J Dig Dis 1973; 18:1095-8. [PMID: 4761532 DOI: 10.1007/bf01076529] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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