Characteristics of recurrent musculoskeletal pain in children with cerebral palsy aged 8 to 18 years

Abstract

CHQ Child Health Questionnaire FPS-R Faces Pain Scale-Revised AIM The aim of this study was to explore the prevalence, predictors, severity, and impact of recurrent musculoskeletal pain in children and adolescents with cerebral palsy (CP).METHOD One hundred and fifty-three participants (81 males, 72 females) aged 8 to 18 years were assessed by clinical examination, interview, and questionnaires. CP type distribution was 38% unilateral spastic, 55% bilateral spastic, 6% dyskinetic, and 1% ataxic. Gross Motor Function Classification System (GMFCS) levels were as follows: level I, 54; level II, 56; level III,20; level IV,8; and level V,15. Sixty-four children and 89 parents recorded pain on the Child Health Questionnaire, 56 children and 85 parents indicated impact of pain on 0 to 10 numeric rating scales, and 72 children indicated pain intensity on the Faces Pain Scale-Revised.RESULTS Ninety-five (62%) children across all GMFCS levels experienced recurrent musculoskeletal pain. Age above 14 years was the only significant predictor (OR 2.90, 95% CI 1.22-7.80, p=0.02, adjusted for sex, CP type, gross motor function and mother's education). Children reported recurrent musculoskeletal pain to be moderate. Parents reported pain to be more severe and with higher impact on sleep than their children did. Children and parents reported similar impact of pain on general activity and walking.INTERPRETATION Recurrent musculoskeletal pain is the dominating pain problem in children and adolescents with CP. Monitoring of musculoskeletal pain should be part of the medical follow-up across the whole range of motor impairment.Musculoskeletal pain is common in children with cerebral palsy (CP) and is also associated with lower quality of life in all domains.1 The problem increases with age. 2 Common body regions involved are the limbs, back, and neck. 3,4 Recognition is important because untreated or undertreated nociceptive pain in childhood may predispose to persisting pain in adulthood through conditioning 2 or through the generation of neuropathic pain, as stimulation of nociceptors may result in changes in the nervous system leading to chronic pain states. 4 The International Association for the Study of Pain defines chronic pain as 'an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage'. 5 The term musculoskeletal pain reflects actual or potential damage of musculoskeletal tissue, but it is an ambiguous concept beyond the anatomical specification, and a diagnosis of musculoskeletal pain has to rely on clinical parameters. In CP, muscle overuse, strain caused by involuntary movements, immobilization, and atypical joint compression from the imbalance of muscle activation across joints are all recognized as potential aetiological factors of nociceptive pain.6 Pain may also be related to health care procedures such as assisted stretching, needle injections, or range of motion manipulation. 7The subjective perception of the individual is the other key ...

Quality of life of Finnish children with cerebral palsy

“…This result underlines the importance of pain management as an integral part of every clinical evaluation. Ramstad et al [19] have arrived at the same conclusion in their research. Recurrent musculoskeletal pain is the dominating pain problem for children and adolescents with CP.…”

Pain in children and adolescents with cerebral palsy: a population‐based registry study

“…Although this level was high, it was still lower than the 50‐75% reported by other CP studies 4, 6, 8, 9, 15. A number of explanations can account for this apparent discrepancy.…”

“…This may have resulted in a higher prevalence than the level found in our study. Some of the other studies focused on specific types of pain, such as musculoskeletal pain 8, or included specific subtypes of CP, for example bilateral spastic 16, both of which could influence the prevalence rate. Furthermore, we included a wide age span, one to 14 years of age, whereas the other studies focused more on pain in adolescents with CP 6.…”

Professionals’ Perceptions about the Need for Pain Management Interventions for Children with Cerebral Palsy in South African School Settings

“…The neurological disorder occurs in 8.4% of children with intellectual disabilities (Christianson et al, 2002). In attempts to correct and rehabilitate orthopedic problems, such as hip dislocations, children with CP often undergo surgical and medical procedures and interventions that may alleviate frequent pain in the long run (Engel & Kartin, 2006;Ramstad, Jahnsen, Skjeldal, & Diseth, 2011). However, painful experiences may arise during procedures such as needle injections, range of motion/movement manipulation, and assisted stretching (Swiggum, Hamilton, Gleeson, & Roddey, 2010).…”