Cincinnati Children’s Hospital Study Addresses How Early Life Surgery Can Influence Later Responses to Pain Interview with:
Michael P. Jankowski, PhD
Theodore W. Striker, MD Chair in Anesthesia Research
Professor and Director of Research
Department of Anesthesia, Division of Pain Management
Cincinnati Children’s Hospital Medical Center What is the background for this study?

Response: It is estimated that chronic pain can affect up to 20% of children undergoing surgery.  We know that alterations in sensory input during critical periods of development can have lasting effects on normal sensory processing later in life.  The developing peripheral nervous system undergoes substantial changes in function during the neonatal period as it receives information from the external environment.  Injuries, including surgery, that occur during this early developmental window can change the way a patient responds to re-injury in adolescence and young adulthood, a phenomenon called neonatal nociceptive priming. 

         At the same neonatal time, the immune system is also developing and responding to changes in the body.  Surgery is known to cause an immune response that is normally activated to facilitate wound healing and regulate acute pain so that the tissues can undergo proper repair after damage.  However, it was not clear how early life surgery could affect the developing immune system to influence pain responses later in life. 

         Since we knew that one particular type of immune cell, the macrophage (which regulates inflammation and tissue repair in addition to acute pain), can play a role in long term responses to surgery, we investigated how this cell type may play a role in the transition from acute post-surgical pain in neonates to prolonged responses to reinjury later in adolescence. 

Migraine: Remote Electrical Neuromodulation For Pain Relief in Adolescents Interview with:
Andrew D. Hershey, MD, PhD, FAAN, FAHS
Endowed Chair and Director of Neurology
Professor of Pediatrics and Neurology
Director, Headache Center
Cincinnati Children’s Hospital Medical Center
Cincinnati, OH 45229
University of Cincinnati, College of Medicine  What is the background for this study?

Response:  Migraine is a common and debilitating disease, affecting 1 in 10 children and adolescents worldwide. Refractory migraine in adolescents may be associated with poorer academic performance, reduced school attendance, and a negative effect on social interactions. Current acute treatments for adolescents with migraine are mostly pharmacological. These treatments may cause side effects, and their frequent use may potentially lead to medication overuse headache. Additionally, their efficacy may be variable or inadequate. Thus, there is a great unmet need for new safe and effective acute treatments for adolescents with migraine headaches.

Remote Electrical Neuromodulation (REN) is a non-pharmacological, non-invasive neuromodulatory treatment that has been approved by the US FDA for acute treatment of the headache attacks of migraine in patients 12 years of age or older. The REN device (Nerivio®) is a small stimulator controlled by the user via a smartphone application and activates one of the body’s own pain suppression system by inducing weak electrical currents. These currents stimulate nerve fibers in the upper arm to activate an endogenous descending pain inhibition mechanism termed Conditioned Pain Modulation (CPM). Clinical trials of REN have shown efficacy and safety of the treatment in adolescents 12 and older, as well as in adults.

The current study is the first to compare REN and standard-care treatments (over the counter medications and triptans) in adolescents.

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