A CHILD'S PAIN

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Berde determined that Alex did indeed have reflex sympathetic dystrophy, a condition in which pain originates from an abnormality in the nerves. In Alex's case, it was due to hyperactivation of nerves running from the spinal cord to the limbs. Alex's legs became hypersensitive to the slightest touch, and they turned blue with cold, for no apparent reason. The cause of the disorder cannot always be determined. It often follows an injury, but Alex's case might have been triggered by a mysterious viral illness. Untreated, the condition can lead to loss of muscle and bone and even permanent disability.

Because Alex's pain was so severe, Berde began by giving him an epidural that numbed his legs for several days, freeing him of pain for the first time in months. Next Alex began an intensive program of physical therapy and counseling. He learned self-hypnosis and imagery to help him cope with the pain, and Berde prescribed antidepressant medications--not because Alex was depressed but because the drugs have been found to quiet the nerve activity that causes neuropathic pain.

Most important was to get Alex moving, to reassure him that physical therapy would not harm him even though it would hurt. Not only would exercise help restore his strength, but Berde had found that it seemed also to help reprogram and quiet the misfiring nerves. Alex spent two months in the hospital. By March, six months after he first became ill, he had begun to walk with a cane. He recovered steadily, though he still needed physical therapy and took several years to regain his strength.

Today Alex, at 18, backpacks, skis, plays tennis and kayaks. But Julia Uihlein thinks that if they had not found their way to Boston, he might never have recovered. She has met other patients with his condition who went untreated for years, and they have not fared well. "Listening to patients," she says. "That's where Dr. Berde started. It seems elementary, but it's really so profound." The greatest tribute, however, is that Alex is thinking about a career in medicine. He spent this summer working for a Milwaukee anesthesiologist who trained under Charles Berde.