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Pain in children following microsurgical reconstruction for obstetrical brachial plexus palsy
Emily S Ho1, Christine G Curtis2, Howard M Clarke1
1Division of Plastic and Reconstructive Surgery and Department of Rehabilitation Services, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Insights
Microsurgical reconstruction for obstetrical brachial plexus palsy (OBPP) is associated with common pain experiences in children. Pain is often frequent but episodic and low-intensity, with neuropathic and musculoskeletal characteristics.
Area of Science:
- Pediatric Surgery
- Neurology
- Pain Management
Background:
- Obstetrical brachial plexus palsy (OBPP) can lead to long-term functional deficits.
- Microsurgical reconstruction is a treatment option for OBPP in infants.
- The long-term sequelae, including pain, require thorough investigation.
Purpose of the Study:
- To determine the prevalence and characteristics of pain in children after microsurgical reconstruction for OBPP.
- To understand the sensory symptoms associated with OBPP post-reconstruction.
Main Methods:
- Prospective case series of 65 children (aged 6-18 years) with OBPP who underwent microsurgery before 12 months of age.
- Pain assessment using the Faces Pain Scale-Revised and Adolescent Pediatric Pain Tool.
- Collection of sensory symptoms in the affected limb.
Main Results:
- Point prevalence of pain was 25%, with a lifetime prevalence of 66%.
- 71% reported their affected extremity felt different; 70% experienced symptoms daily or weekly.
- Pain was described using terms for neuropathic and musculoskeletal symptoms, with low average intensity.
Conclusions:
- Children undergoing microsurgical reconstruction for OBPP frequently experience pain.
- Pain symptoms are typically frequent but episodic and of low intensity.
- Pain descriptions suggest both neuropathic and musculoskeletal origins.
Purpose:
To determine the prevalence and characteristics of pain experienced by children who have had microsurgical reconstruction for obstetrical brachial plexus palsy (OBPP).
Methods:
A prospective case series study was conducted of 65 children aged 6 to 18 years with a diagnosis of OBPP and who had microsurgery at less than 12 months of age with nerve grafting or transfer. A total of 28 patients (43%) had upper OBPP and 37 (57%) had total OBPP. We evaluated pain using the Faces Pain Scale-Revised and the Adolescent Pediatric Pain Tool. Sensory symptoms in the affected limb were also collected. Mean age was 11.0 ± 3.3 years.
Results:
We evaluated 65 children. The point prevalence of pain (pain at the time of assessment) was 25%. The reported lifetime prevalence of pain (experienced anytime during life) was 66%. A total of 71% reported that the affected extremity felt different at least once in their lifetime. Average intensity of those with pain (n = 43) was 40 ± 19 mm on a 100-mm visual analog scale. Seventy percent of children reported that symptoms occurred every day or at least once a week. Anatomical distribution of pain was throughout the affected upper extremity irrespective of the severity of injury, with the exception of children with upper plexus injuries who did not report pain in their hand. Words typically used to describe neuropathic or musculoskeletal symptoms were chosen by the children to represent their pain.
Conclusions:
Children with OBPP who had microsurgical reconstruction commonly reported pain. These symptoms were typically frequent but were episodic and low in intensity. The descriptions of the type of pain include terms typical of both neuropathic and musculoskeletal origins.
Type Of Study/Level Of Evidence:
Prognostic IV.
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