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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 key—right 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."

RSDSA Review.

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