Focus on... Dr. Charles Berde
By Daria Charlesworth
Easy to engage and personable, Dr.
Charles Berde doesn't look like the world's preeminent authority
on pediatric RSD. One can imagine him swapping knock-knock
jokes with his pint-sized patients, aware that such developmentally
appropriate silliness is a good indication of adequate pain
control. Dr. Berde, staff anesthesiologist Navil Sethna,
and psychologist Bruce Masek started the first multidisciplinary
pain clinic for children at Boston Children's Hospital in
1986. Today it is a major center for RSD treatment of children,
as well as for treatment of many other chronic pain problems.
The clinic has treated over 600 children
with RSD since 1986, both inpatient and outpatient. How have
they done, over the long term? "My guess is the majority
are doing well," says Dr. Berde. "But we don't know
for sure, because we haven't done a study."
He hopes that the clinic can follow
up with these 600 former patients over the next few years."
This study is ready, but we still need to fund it. Research
funding for RSD is a tough go."
Nonetheless, the Boston clinic has
done many studies on treatment modalities for RSD. Dr. Berde
presented two at the International Update Conference in Tampa:
the first demonstrating that a program of physical therapy
and cognitive behavioral therapy was effective in decreasing
pain, increasing functioning, and increasing ability to walk
in two randomized groups of children with RSD of the lower
extremity, and the second showing that sympathetic blockade
improved pain and functioning in most children. Berde is dedicated
to studying RSD according to rigorous scientific protocols,
because scientific study and published results give credence
to what physicians have observed and to what patients have
experienced. Yet he is very aware of the ethical limitations
in creating a double-blinded placebo study using children
in pain. "The studies are difficult to design, but we
have had success while being aware of each child's needs."
The importance of a multidisciplinary
approach in the treatment of pediatric RSD is stressed by
Dr. Berde. The anesthesiologist, neurologist, psychologist,
physical therapist, occupational therapist, and child life
specialist are all- important members of the team. Many modalities
may be used for treatment, including medication, sympathetic
blockade, physical movement therapies, cognitive behavioral
therapies (including biofeedback), and sometimes sympathectomy
or spinal cord stimulators or pumps. Dr. Berde stresses the
importance of physical movement and weight-bearing, not only
to keep the limb from atrophy, but because he believes exercise
helps to quiet the small nerve fibers on a molecular level.
And what does he see in the future?
"I think we have every reason to be hopeful. Right now
we can treat the majority of kids successfully, and we will
get better at treating those kids whose treatment is not so
successful. Funding for research is the keyright now
we have four multidisciplinary children's hospitals on board
for clinical trials, the protocols are all set, and we have
applied for funding. Hopefully we will be able to follow through
with multicenter studies that show us what does and does not
work for RSD in kids."