Acute and chronic pain in children and adolescents with cerebral palsy: prevalence, interference and management

Publication date: Available online 12 September 2019

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Katarina Ostojic, Simon Paget, Maria Kyriagis, Angela Morrow

Abstract

Objective

To determine the prevalence, impact and management of acute and chronic pain amongst youth aged 5-18 years with cerebral palsy, attending outpatient rehabilitation services.

Design

A cross-sectional study using the Faces Pain Scale-Revised, Patient Reporting Outcomes Measurement Information System Pediatric Pain Interference Scale and Cerebral Palsy Quality of Life questionnaire. Where children were unable to self-report, parent/caregiver proxy was obtained.

Setting

Outpatient rehabilitation.

Participants

280 participants with cerebral palsy aged 5-18 years and/or their parent/caregiver. 45.7% (n=128) self-report and 54.3% (n=152) proxy-report.

Interventions

Not applicable.

Main outcome measure

Presence/absence of acute and chronic pain. Secondary measures were pain intensity, pain interference, pain management and quality of life.

Results

Acute pain and chronic pain were reported by 67.1% and 31.4% of participants respectively. Of those reporting acute pain, 42% also experienced chronic pain. Factors that increased the odds of chronic pain were: predominately dyskinesia (OR= 3.52; 95% CI: 1.64-7.55); mixed spasticity-dyskinesia (OR= 1.93; 95% CI: 1.07-3.47); bilateral involvement (OR= 3.22; 95% CI: 1.844-5.61) and GMFCS level IV (OR= 2.32; 95% CI: 1.02 – 5.25) and V (OR= 3.73; 95% CI: 1.70 – 8.20). Pain frequently interferes with sleep, attention, ability to have fun and quality of life. Short-acting pharmacological analgesics, thermotherapy, hydrotherapy and massage were commonly used for pain management.

Conclusions

Routine screening for pain is critical for early identification and intervention. Multimodal interventions are needed to address the biopsychosocial model of pain, and should be tailored for all abilities across the CP spectrum.

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