Spasticity-related pain in children/adolescents with cerebral palsy. Part 1: Prevalence and clinical characteristics from a pooled analysis

Abstract

PURPOSE: A large prospective database from three Phase 3 studies allowed the study of spasticity-related pain (SRP) in pediatric cerebral palsy (CP). METHODS: Baseline (pretreatment) SRP data occurring during different activities in children/adolescents (aged 2–17 years, ambulant/nonambulant) with uni-/bilateral spastic CP was obtained using the Questionnaire on Pain caused by Spasticity (QPS; six modules specific to spasticity level [lower limb (LL) or upper limb (UL)] and type of respondent [child/adolescent, interviewer, or parent/caregiver]). RESULTS: At baseline, 331 children/adolescents with LL- and 155 with UL-spasticity completed at least one key item of their modules; LL/UL QPS modules of parent/caregivers were at least partially completed (key items) by 841/444 parents/caregivers. SRP with at least one activity at baseline was self-reported in 81.9% /69.7% (LLs/ULs) of children/adolescents with spasticity. Parents/caregivers observed LL/UL SRP behaviors in 85.9% /77.7% of their children, with multiple body regions affected. SRP negatively affected the great majority of the children in various ways. Child/adolescent-reported mean SRP intensity and parent/caregiver-observed mean SRP behavior frequencies were higher for LLs than ULs, and the level of SRP increased with more physically demanding activities. CONCLUSION: These data suggest SRP is more common and intense in pediatric CP than generally thought, emphasizing the need for effective, long-term pain management.

Spasticity-related pain in children/adolescents with cerebral palsy. Part 2: IncobotulinumtoxinA efficacy results from a pooled analysis

“…1 of this two-part report, pain, i.e., SRP as measured by the QPS, was highly prevalent in this CP population [28]. A significant reduction in the intensity of SRP for children/adolescents reporting SRP at baseline was demonstrated after one cycle of incobotulinumtoxinA treatment.…”

“…The current results provide evidence of substantial, clinically meaningful reductions in the frequency and intensity of SRP after incobotulinumtoxinA treatment in a large pediatric population with CP-related spasticity. As reported and discussed in Part 1 of this two-part report, pain, i.e., SRP as measured by the QPS, was highly prevalent in this CP population [ 28 ]. A significant reduction in the intensity of SRP for children/adolescents reporting SRP at baseline was demonstrated after one cycle of incobotulinumtoxinA treatment.…”

“…The QPS comprises six modules specific to the level of spasticity (LL and UL) and respondent (self-reports by children/adolescents, interviewer-reported children/adolescents, and parents/caregivers). In each module, SRP was assessed for different levels of task difficulty, ranging from rest to self-described hard tasks (see Table 1 of Part 1 of the accompanying publication [Heinen et al 2021] [ 28 ] for further details of QPS items). For children/adolescents, SRP intensity was assessed with the following QPS key items: General SRP (Item 2); SRP at rest (Item 4); SRP with usual activities (Item 6); SRP with exercises (Item 8); and SRP with a self-defined hard task (Item 11).…”

“…The QPS key items for the parent/caregiver analysis were: General SRP (Item 8); SRP at rest (Item 9b); SRP with usual activities (Item 10b); SRP with exercises (Item 11b); and SRP with a self-defined hard task (Item 13b) (adapted from [ 27 ]). Further details regarding the QPS can be found in Table 1 of Part 1 [ 28 ].…”

“…In the first publication, it was demonstrated that at baseline— prior to treatment with incobotulinumtoxinA— more than 80% of children/adolescents with LL spasticity and almost 70% with UL spasticity reported SRP. The parents and caregivers of these children observed even higher SRP prevalence [ 28 ]. SRP was reported in multiple body sites and had widespread and detrimental effects on activities and behavior, highlighting the need for better SRP control for most children with CP.…”