Sunday, December 23, 2007

Doctor's intense routine produces 92% cure rate

Doctor's intense routine produces 92% cure rate

Sunday, December 16, 2007

Amplified pain problems such as Kara Loree's complex regional pain syndrome are rare. Physicians who don't specialize in pediatric pain frequently don't recognize or know how to treat it. That leads many parents to consult with dozens of doctors, and children to spend months or years in pain before they find relief.

Since the condition first was recognized in children in 1971 -- it's been seen in adults since the Civil War -- clinicians have tailored treatments to individual patients. They've prescribed everything from anti-inflammatory medications and nerve blocks to physical therapy and acupuncture.

No single treatment has been proved in clinical trials to be more effective, said Dr. Lonnie Zeltzer, director of the Pediatric Pain Program at Mattel Children's Hospital at the University of California at Los Angeles.

What works for one child doesn't necessarily work for another.

But since 1984, Dr. David Sherry, a Children's Hospital of Philadelphia rheumatologist, has treated about 1,400 youngsters with amplified pain syndromes such as Kara's. He claims a 92 percent cure rate with children who could tolerate the inpatient program he and colleagues developed when Sherry practiced at a Seattle hospital.

With vigorous exercise and talk therapy, the medical team retrains children's brains and nervous systems to recognize pain signals differently. The children push through pain to get past it.

Sherry's program addresses stresses known to influence the neurobiology of pain: 80 percent of pediatric patients with complex regional pain syndrome are girls, and most are perfectionist high achievers in school and extracurricular activities. Difficulty handling stresses of daily life is thought to contribute to their pain.

Legacy Emanuel Children's Hospital doctors traditionally treated such patients as outpatients. But early this year, Emanuel sent doctors and therapists to study with Sherry, then set up a similar inpatient program at the North Portland hospital.

"I'm continually amazed by these kids," Sherry said. "No matter how bad they are, they get better without medications."

-- Katy Muldoon

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