Left to themselves: Time to target chronic pain in childhood rare diseases

Christine B Sieberg; Alyssa Lebel; Erin Silliman; Scott Holmes; David Borsook; Igor Elman

doi:10.1016/j.neubiorev.2021.03.008

Left to themselves: Time to target chronic pain in childhood rare diseases

Neurosci Biobehav Rev. 2021 Jul:126:276-288. doi: 10.1016/j.neubiorev.2021.03.008. Epub 2021 Mar 24.

Authors

Christine B Sieberg¹, Alyssa Lebel², Erin Silliman³, Scott Holmes², David Borsook⁴, Igor Elman⁵

Affiliations

¹ 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.
² 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.
³ 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.
⁴ 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. Electronic address: dblabore@gmail.com.
⁵ 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.

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.

Keywords: Acute pain; Arthritis; Bone; Chronic pain; Clinical trials; Metabolism; Muscle; Neuropathic pain; Psychosocial.

Publication types

Research Support, N.I.H., Extramural
Review

MeSH terms

Brain
Chronic Pain*
Emotions
Humans
Rare Diseases

Abstract

Publication types

MeSH terms

Grants and funding