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Change in pain status in children with cerebral palsy
Rhandi Christensen1, Alexander MacIntosh2, Lauren Switzer2
1Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Insights
Children with cerebral palsy (CP) experiencing more severe initial pain and higher gross motor function showed reduced pain over time. This suggests an improvement in pain status for these children.
Area of Science:
- Pediatric neurology
- Pain management
- Rehabilitation medicine
Background:
- Chronic pain is a significant issue for children with cerebral palsy (CP).
- Understanding pain trajectories is crucial for effective management strategies.
Purpose of the Study:
- To identify factors predicting changes in pain over time in children with CP.
- To analyze the relationship between initial pain severity, motor function, and pain evolution.
Main Methods:
- Longitudinal assessment of pain using caregiver-reported Health Utilities Index 3 (HUI3) scores in 148 children with CP.
- Statistical analysis including backward stepwise multiple linear regression to identify associated factors.
- Inclusion of children across all Gross Motor Function Classification System (GMFCS) levels.
Main Results:
- Fifty-five percent of children experienced changes in caregiver-reported HUI3 pain scores.
- Initial HUI3 pain score and GMFCS level were significant predictors of pain change (R² = 0.35, p < 0.001).
- Musculoskeletal pain etiology showed the most significant improvement compared to other pain types.
Conclusions:
- Children with CP presenting with higher initial pain and better gross motor function tend to report lower pain at follow-up.
- These findings indicate a potential improvement in pain status over time for specific subgroups of children with CP.
- Pain etiology is associated with pain trajectory, with musculoskeletal pain improving most notably.
Aim:
To identify factors associated with a change in pain over time in children with cerebral palsy (CP).
Method:
Pain was assessed at two time-points by physicians and caregiver-rated Health Utilities Index 3 (HUI3) pain scores.
Results:
One hundred and forty-eight children out of 179 approached from outpatient clinics (83% response; 104 males, 44 females mean age 8y 8mo, range 3y-16y) across all Gross Motor Function Classification System (GMFCS) levels were included. Fifty-five percent had changes in caregiver-reported HUI3 pain. A backward stepwise multiple linear regression retained HUI3 pain score at visit 1 and GMFCS level (F[2,144] =23.40, R2 =0.35; p<0.001) as variables associated with a change in pain status (HUI3 pain at visit 1: β=0.61, p<0.001; GMFCS level: β=-0.17, p<0.015). The association between HUI3 pain at visit 1 and GMFCS level was significant (β=-0.15, p<0.036). There was an association between pain etiology and pain trajectory (F[3,144] =5.39, p=0.002). Post-hoc testing revealed musculoskeletal pain had the greatest improvements compared with the no pain group (p=0.006).
Interpretation:
Children with CP with more severe initial pain and higher gross motor function have lower pain at follow-up indicating an improvement in pain status over time.
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