Outcomes, Clinical Effectiveness, of Gabapentin and Oxcarbazepine for Chronic Neuropathic Pain in Children and Adolescents | Overview
Clinical trials evaluating the efficacy and effectiveness of analgesic medications and pain interventions pose ethical and scientific challenges when studied in the pediatric population particularly when the interventions are invasive and due to the burden of pain in children. Therefore the use of retrospective, case control and other clinical study designs, as well as applied statistical methods are important for the initial assessments of effectiveness and for generating thoughtful and guided hypotheses when designing future clinical trials. Some of our ongoing outcomes projects include:
1. Pain treatment outcomes in children with Complex Regional Pain Syndrome (CRPS)
Despite great advances in treatment of children with chronic pain conditions (CPC) in hospital-based rehabilitation programs that include occupational and physical therapy and psychological treatment, there is still no consensus in the efficacy of regional anesthesia in the management of chronic pain conditions (e.g. CRPS and focal dystonia), especially in children.
The primary aim of our study is to assess the functional outcomes of children with CPC, hospitalized and treated with regional anesthesia in the Pain Service at Boston Children’s Hospital (BCH), from the year 2003 onward.
Research Contact: Carolina.DonadoRincon@childrens.harvard.edu
2. A Retrospective Chart Review Examining the Effect of Lumbar Medial Branch Blocks on Extension Related Axial Chronic Low Back Pain among the Pediatric Population
There has been an increase in the prevalence of low back pain in children and adolescents in recent years. A diagnostic and therapeutic approach to managing axial low back pain related to the facet joint is the lumbar medial branch blockade however effects of the lumbar medial branch block treatment among the pediatric population is still lacking.
The primary aim of this study is to study the improvement in extension related axial chronic low back pain among pediatric patients, before and after receiving lumbar medial branch blocks at the Boston Children’s Hospital Pain Service from the year 2009-2015. The primary outcome will be greater than fifty percent improvement in pain, functional, and psychosocial scores after receiving lumbar medial branch block treatment.
Research Contacts: Kimberly.Lobo@childrens.harvard.edu and Carolina.DonadoRincon@childrens.harvard.edu
3. A Retrospective Chart Review Studying the Effect of Abdominal Wall Nerve Blocks for ACNES in a Pediatric Population
Chronic abdominal pain is an intermittent or continuous abdominal discomfort caused by etiologies ranging from organic to functional. Treatment of anterior cutaneous nerve entrapment syndrome (ACNES) is challenging given the lack of research and possible need for a multidisciplinary approach. Analyses of treatment methods and alternatives are vital in order to efficiently and safely provide care for this syndrome in a time sensitive manner.
The overall goal of this retrospective chart review is to study the change in pain in pediatric patients presenting with anterior cutaneous nerve entrapment syndrome (ACNES), before and after receiving an abdominal wall block at the Boston Children’s Hospital Pain Service from January 2009—October 2015. We will define the primary outcome as a steady change in pain.
Research Contacts: Kimberly.Lobo@childrens.harvard.edu and Carolina.DonadoRincon@childrens.harvard.edu