Dissociation between individual differences in self-reported pain intensity and underlying fMRI brain activation.

Pain is an individual experience. Previous studies have highlighted changes in brain activation and morphology associated with within- and interindividual pain perception. In this study we sought to characterize brain mechanisms associated with between-individual differences in pain in a sample of healthy adolescent and adult participants (N = 101). Here we show that pain ratings varied widely across individuals and that individuals reported changes in pain evoked by small differences in stimulus intensity in a manner congruent with their pain sensitivity, further supporting the utility of subjective reporting as a measure of the true individual experience. Furthermore, brain activation related to interindividual differences in pain was not detected, despite clear sensitivity of the Blood Oxygenation Level-Dependent (BOLD) signal to small differences in noxious stimulus intensities within individuals. These findings suggest fMRI may not be a useful objective measure to infer reported pain intensity.

Depression and functional disability in chronic pediatric pain.

OBJECTIVES: The primary aim of this study was to describe pain characteristics, coping strategies, depression, and functional disability in children and adolescents with chronic pain and to examine potential factors that are associated with functional disability in a pediatric pain population. The secondary aim of this study was to compare functional disability in two chronic pain conditions: localized musculoskeletal pain and chronic daily headaches. SUBJECTS: The participants in this study were 73 pediatric pain patients with a variety of chronic pain conditions. Subjects in the second part of the study were a subset of patients (N = 44) from the pain clinic sample with chronic localized musculoskeletal pain and a subset of patients (N = 38) from the headache center of the same hospital who had chronic daily headaches. DESIGN: Patients completed self-report measures of pain intensity, depression, coping strategies, coping efficacy, and functional disability. RESULTS: Results indicated that chronic pain had a substantial impact on the children's lives and that depression was strongly associated with functional disability. Maladaptive coping was correlated with depression and disability; however, maladaptive coping was not independently associated with functional disability. A comparison between the two groups found significant differences in pain intensity and functional disability. The localized musculoskeletal pain group reported higher levels of disability and more difficulty coping than the chronic daily headache group. CONCLUSIONS: The implications for treatment of chronic pain in children are discussed with an emphasis on greater attention to developmental issues and their relation to coping, emotional functioning, and disability in pediatric pain. Further research examining differences in coping and disability between different pediatric pain groups is also warranted.

The incidence of tissue coring during the performance of caudal injection in children.

BACKGROUND AND OBJECTIVES: The performance of caudal injection (CI) has become a routine part of pediatric anesthesia. The intraoperative and immediate postoperative complications of CIs have been reported extensively. Although the long-term consequences of CI are unknown, they may include the development of epidermoid tumors in the spinal canal. Such tumors have been attributed to tissue coring (the process by which pieces of tissue are removed by a needle as it passes through the tissue) and the subdural deposition of such tissue. METHODS: In this study, we examine the internal needle of 20-gauge i.v. cannulae from 50 CIs for evidence of tissue coring. RESULTS: We found a total coring incidence of 54% (95% confidence interval = 40-68%). Epidermal tissue was present in 33% of the positive samples. Fat was present in 67% of the positive samples and bloody material in 26%. This study provides an estimate (with a 95% confidence interval) of the rate of coring during CI performed with hollow point needles. CONCLUSIONS: These findings suggest that technical modifications may improve patient safety. The results also have implications for long-term follow-up of caudal anesthetics. Techniques for reducing the incidence of tissue coring during the performance of CI are discussed.

Diagnostic pitfalls in the diagnosis of soft tissue bladder tumors in pediatric patients.

This is a case report of a low-grade leiomyosarcoma of the bladder in a four-year-old girl. The pitfalls in diagnosing a soft tissue tumor of the bladder in pediatric patients are discussed. This case is particularly instructive because the differential diagnosis was broad, difficult, and of serious consequence. This report discusses the process by which histologic, immunohistologic and ultrastructural data were used to sidestep the pitfalls in diagnosing this unusual tumor. Clinical follow-up data bearing out our conclusion are also presented.

Cyclic neutropenia: a case of asymptomatic appendicitis.

A seven year old boy with a history of cyclic neutropenia (CN) was admitted to the hospital after developing fever and chills following a bicycle accident. After admission, he had a rapidly deteriorating hospital course leading to shock and death. At autopsy, acute appendicitis with resultant peritonitis and sepsis was diagnosed. The peculiar clinical and microscopic aspects of this case will be presented and contrasted with the more usual signs and symptoms of this cyclic disease.