Acute and Chronic Pain in Children and Adolescents With Cerebral Palsy: Prevalence, Interference, and Management

Katarina Ostojic; Simon Paget; Maria Kyriagis; Angela Morrow

doi:10.1016/j.apmr.2019.08.475

Acute and Chronic Pain in Children and Adolescents With Cerebral Palsy: Prevalence, Interference, and Management

Arch Phys Med Rehabil. 2020 Feb;101(2):213-219. doi: 10.1016/j.apmr.2019.08.475. Epub 2019 Sep 12.

Authors

Katarina Ostojic¹, Simon Paget², Maria Kyriagis³, Angela Morrow²

Affiliations

¹ Discipline of Child and Adolescent Health, The University of Sydney Children's Hospital Westmead Clinical School, Sydney, Australia; Kids Rehab, The Children's Hospital at Westmead, Sydney, Australia; Cerebral Palsy Alliance, The University of Sydney, Sydney, Australia. Electronic address: katarina.ostojic@health.nsw.gov.au.
² Discipline of Child and Adolescent Health, The University of Sydney Children's Hospital Westmead Clinical School, Sydney, Australia; Kids Rehab, The Children's Hospital at Westmead, Sydney, Australia.
³ Rehab2Kids, Sydney Children's Hospital Randwick, Sydney, Australia; School of Women's & Children's Health, University of New South Wales, Sydney, Australia.

PMID: 31521713
DOI: 10.1016/j.apmr.2019.08.475

Abstract

Objective: To determine the prevalence, interference, and management of acute and chronic pain among youth with cerebral palsy (CP) aged 5-18 years 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 the Cerebral Palsy Quality of Life questionnaire. Where children were unable to self-report, parent or caregiver proxy was obtained.

Setting: Outpatient rehabilitation.

Participants: Participants (N=280) with CP aged 5-18 years and their parent or caregiver. Self-report was obtained by 45.7% (n=128) and proxy-report was obtained by 54.3% (n=152) of the cohort.

Interventions: Not applicable.

Main outcome measures: Presence or absence of acute pain 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 (odds ratio [OR]=3.52; 95% confidence interval [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 Gross Motor Function Classification System 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 pharmacologic 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.

Keywords: Cerebral palsy; Pain; Pediatrics; Rehabilitation.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Acute Disease
Adolescent
Age Factors
Attention / physiology
Cerebral Palsy / epidemiology*
Cerebral Palsy / physiopathology
Child
Child, Preschool
Chronic Pain / epidemiology
Chronic Pain / physiopathology
Cross-Sectional Studies
Dyskinesias / epidemiology
Female
Humans
Male
Motor Skills
Muscle Spasticity / epidemiology
Pain / epidemiology*
Pain / physiopathology
Pain Management / methods*
Quality of Life*
Sex Factors
Sleep / physiology
Socioeconomic Factors