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

Ostojic, Katarina; Paget, Simon P; Kyriagis, Maria; Morrow, Angela M

doi:10.1016/j.apmr.2019.08.475

Cited by 70 publications

(118 citation statements)

References 24 publications

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“…However, participants with chronic pain in this study did not discuss using psychological therapies, nor had they accessed psychological services in the 3 months prior to completing the crosssectional pain study. Minimal use of psychological therapy was also reported by a recent Australian study of a broad CP cohort with chronic pain, highlighting possible gaps in service delivery in this area [33]. Despite children not formally using psychological interventions in this study, some did self-adopt ad hoc components of interventions such as mindfulness, including strategies such as controlled breathing and distraction, which they found helpful [40].…”

Section: Discussionmentioning

confidence: 49%

“…Despite high chronic pain prevalence being previously reported amongst children with CP and dyskinesia, no studies have explored qualitative perspectives of those able to self-report [33]. However a previous qualitative study has been undertaken of a broad CP cohort (across all subtypes) of adolescents and young adults with chronic pain able to verbalize their experiences [34].…”

Section: Discussionmentioning

confidence: 99%

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The lived experience of chronic pain and dyskinesia in children and adolescents with cerebral palsy

et al. 2020

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Background: To explore the lived experience of chronic pain and dyskinesia in children and adolescents with cerebral palsy. Methods: A convergent parallel mixed methods design was undertaken. First, a quantitative cross-sectional study of participants able to self-report their quality of life was undertaken. This study characterised pain chronicity, intensity, body locations, and quality of life. Second, semi-structured interviews were undertaken with a subset of children and adolescents experiencing chronic pain. Results: Twenty-five children and adolescents took part in the cross-sectional study, 23 of whom experienced chronic pain and 13 of moderate intensity. Pain was often located in multiple bodily regions (6/21), with no trends in quality of life outcomes detected. Eight participated in semi-structured interviews, which identified three key themes including 'lives embedded with dyskinesia', 'real world challenges of chronic pain', and 'still learning strategies to manage their pain and dyskinesia'. Conclusions: A high proportion of children and adolescents with cerebral palsy and dyskinesia who were able to self-report experienced chronic pain. The physical and emotional impacts of living with chronic pain and dyskinesia existed along a spectrum, from those with lesser to greater extent of their impacts. Children and adolescents may benefit from targeted chronic pain education and management within bio-psychosocial models.

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Section: Discussionmentioning

confidence: 49%

Section: Discussionmentioning

confidence: 99%

The lived experience of chronic pain and dyskinesia in children and adolescents with cerebral palsy

et al. 2020

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“… 11 However, ‘having pain or discomfort’ and ‘pain’ were only moderately correlated in CYP with CP (r=0.47). Many CYP with CP experience frequent pain, 29 and as a result, their interpretation of the EQ-5D-Y question about pain and discomfort may differ to their interpretation of the CHU-9D question about pain only. Indeed, 56% of CYP with CP reported no pain or discomfort on the EQ-5D-Y, while 62% reported no pain on the CHU-9D.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the CHU-9D and the EQ-5D-Y instruments in children and young people with cerebral palsy: a cross-sectional study

et al. 2020

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ObjectiveTo compare the performance of the EuroQol 5D youth (EQ-5D-Y) and child health utility 9D (CHU-9D) for assessing health-related quality of life (HRQoL) in children and young people (CYP) with cerebral palsy (CP).DesignCross-sectional study.SettingEngland.ParticipantsSixty-four CYP with CP aged 10–19 years in Gross Motor Function Classification System (GMFCS) levels I–III.Main outcome measuresMissing data were examined to assess feasibility. Associations between utility values and individual dimensions on each instrument were examined to assess convergent validity. Associations between utility values and GMFCS level were examined to assess known-group differences.ResultsMissing data were <5% for both instruments. Twenty participants (32.3%) and 11 participants (18.0%) reported full health for the EQ-5D-Y and CHU-9D, respectively. There was poor agreement between utilities from the two instruments (intraclass correlation coefficient=0.62; 95% limits of agreement −0.58 to 0.29). Correlations between EQ-5D-Y and CHU-9D dimensions were weak to moderate (r=0.25 to 0.59). GMFCS level was associated with EQ-5D-Y utility values but not CHU-9D utility values.ConclusionThe EQ-5D-Y and CHU-9D are feasible measures of HRQoL in CYP with CP. However, the two instruments demonstrate poor agreement and should not be used to measure and value HRQoL in CYP with CP interchangeably. We propose that the CHU-9D may be preferable to use in this population as it assesses concepts that influence HRQoL among CYP with CP and provides less extreme utility values than the EQ-5D-Y.

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“…12 Both children with mixed (dyskinetic/ spastic) and predominant dyskinetic motor types have been reported to be at risk of pain, with a need to explore pain characteristics within both of these important subpopulations. 13 Pain management is complicated by multifactorial pain sources and mechanisms that place children with predominant dyskinetic and mixed (dyskinetic/spastic) CP motor types at risk of under detected and undertreated pain. 14,15 As children grow, pain may be caused by non-invasive management (e.g.…”

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confidence: 99%

Pain in children with dyskinetic and mixed dyskinetic/spastic cerebral palsy

McKinnon

Morgan

Antolovich

et al. 2020

Develop Med Child Neuro

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To evaluate pain prevalence and characteristics in children and adolescents with predominant dyskinetic and mixed (dyskinetic/spastic) cerebral palsy (CP) motor types. METHOD Seventy-five participants with a diagnosis of CP and confirmed dyskinetic or mixed (dyskinetic/spastic) motor type took part in a multisite cross-sectional study. The primary outcome was carer-reported pain prevalence (preceding 2wks) measured using the Health Utilities Index-3. Secondary outcomes were chronicity, intensity, body locations, quality of life, and activity impact. RESULTS Mean participant age was 10 years 11 months (SD 4y 2mo, range 5-18y). There were 44 males and 31 females and 37 (49%) had predominant dyskinetic CP. Pain was prevalent in 85% and it was chronic in 77% of participants. Fifty-two per cent experienced moderate-to-high carer-reported pain intensity, which was significantly associated with predominant dyskinetic motor types (p=0.008). Pain occurred at multiple body locations (5 out of 21), with significantly increased numbers of locations at higher Gross Motor Function Classification System levels (p=0.02). Face, jaw, and temple pain was significantly associated with predominant dyskinetic motor types (p=0.005). Poorer carer proxy-reported quality of life was detected in those with chronic pain compared to those without (p=0.03); however, chronic pain did not affect quality of life for self-reporting participants. INTERPRETATION Pain was highly prevalent in children and adolescents with predominant dyskinetic and mixed (dyskinetic/spastic) motor types, highlighting a population in need of lifespan pain management.

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

Cited by 70 publications

References 24 publications

The lived experience of chronic pain and dyskinesia in children and adolescents with cerebral palsy

The lived experience of chronic pain and dyskinesia in children and adolescents with cerebral palsy

Comparison of the CHU-9D and the EQ-5D-Y instruments in children and young people with cerebral palsy: a cross-sectional study

Pain in children with dyskinetic and mixed dyskinetic/spastic cerebral palsy

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