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Prevalence of pain in 240 non-ambulatory children with severe cerebral palsy
I Poirot1, V Laudy2, M Rabilloud3
1Service de médecine physique et réadaptation pédiatrique, hospices civils de Lyon, 69677 Bron, France.
Insights
Pain is common in children with cerebral palsy (CP), affecting over 27%. This study highlights the need for systematic pain assessment and targeted interventions for orthopedic and spasticity-related pain in non-ambulatory children with CP.
Area of Science:
- Pediatric Orthopedics
- Neurology
- Pain Management
Background:
- Prevalence of pain in children with cerebral palsy (CP) varies across studies, hindering comparisons.
- This study focuses on estimating pain prevalence in non-ambulatory children with CP and characterizing pain experiences.
Purpose of the Study:
- To estimate the prevalence of pain in non-ambulatory children with severe cerebral palsy (CP).
- To describe the characteristics of pain in these children, differentiating between those with and without pain.
Main Methods:
- Longitudinal national cohort data of 240 non-ambulatory children (3-10 years) with severe CP were analyzed.
- Pain was assessed using visual analog scales, Douleur Enfant San Salvadour scales, and investigator interviews.
- Data were compared between children experiencing pain and those without pain at inclusion.
Main Results:
- A prevalence of 27.1% (95% CI 22-33%) for pain was observed in the study population.
- All pain reported was orthopedic, with hips (43.4%) and feet (26.9%) being the most common sites.
- Pain was significantly associated with scoliosis (43.1% vs 24.1%) and spasticity treatment (32.3% vs 17.2%).
Conclusions:
- Children with cerebral palsy frequently experience early, primarily articular and orthopedic pain.
- Systematic pain assessment is crucial due to the high prevalence.
- Interventions targeting scoliosis, hip/foot deformities, and spasticity, alongside pre-exercise analgesia, may reduce pain prevalence.
Background:
Several studies have given frequencies of pain in children with cerebral palsy, but comparing the findings is difficult. We aimed to estimate the prevalence of pain in non-ambulatory children with cerebral palsy and describe their characteristics by presence or absence of pain.
Methods:
Data were extracted from an ongoing longitudinal national cohort following non-ambulatory children with severe cerebral palsy aged 3 to 10years over 10years. We described and compared data for the first 240 children at inclusion by presence or absence of pain. Pain was assessed by a visual analog scale and the Douleur Enfant San Salvadour scales and by investigator interview.
Results:
Overall, 65 children experienced pain, for a prevalence of 27.1% (95% confidence interval 22-33%). All children experiencing pain had orthopaedic pain and 45.6% had pain from another origin. The main pain sites were hips (43.4%) and feet (26.9%). Joint mobilisation was the source of pain for 58.3% of children experiencing pain, and sitting was identified as painful for 10.3%. Pain was greater with scoliosis (43.1% vs 24.1% with and without pain; P=0.006) and spasticity treatment (32.3% vs 17.2%; P=0.020).
Conclusion:
Children with cerebral palsy frequently experience pain and also early pain, mostly articular and orthopedic. The assessment of pain should be systematic because of its high prevalence. Interventions to prevent scoliosis, hip luxation, and foot deformities and to reduce spasticity, such as the use of analgesics before joint mobilization exercises, may reduce the prevalence of this pain.
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