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Musculoskeletal Pain Outcomes Pre- and Post Intrathecal Baclofen Pump Implant in Children With Cerebral Palsy: A
Chantel C Barney1,2, Alyssa M Merbler1, Jean Stansbury2
1Department of Educational Psychology, University of Minnesota, Minneapolis, Minnesota.
Insights
Intrathecal baclofen (ITB) pump placement significantly reduced constant musculoskeletal pain in children with cerebral palsy (CP). The duration of pain experience was most notably improved following ITB therapy.
Area of Science:
- Pediatric neurology
- Pain management
- Rehabilitation medicine
Background:
- Musculoskeletal pain is a common challenge for children with cerebral palsy (CP).
- Intrathecal baclofen (ITB) pump therapy is used to manage spasticity in CP, but its effect on pain is less understood.
Purpose of the Study:
- To evaluate the impact of intrathecal baclofen pump placement on musculoskeletal pain intensity, duration, frequency, and daily activity interference in children with CP.
Main Methods:
- Prospective cohort study involving 32 children with CP (mean age 9.9 years) at a tertiary hospital.
- Pain assessments using the Brief Pain Inventory and Dalhousie Pain Interview were conducted by parent proxy before and approximately 6 months after ITB pump implantation.
- The majority of participants had quadriplegia (76%) and relied on wheeled mobility (91%).
Main Results:
- A significant reduction in the percentage of children experiencing constant pain, from 31% pre-implant to 6% post-implant (P<.001).
- A statistically significant decrease in pain duration was observed after ITB pump placement (P<.01).
Conclusions:
- ITB pump implantation is effective in reducing musculoskeletal pain in children with CP, supporting existing evidence.
- The most significant improvement was noted in the duration of pain experienced.
- Further research is warranted to identify patient characteristics that predict pain reduction outcomes.
Objective:
To characterize musculoskeletal pain intensity, duration, frequency, and interference with activities of daily living in children with cerebral palsy (CP) before and after intrathecal baclofen pump placement.
Design:
Prospective cohort study.
Setting:
Children's tertiary hospital.
Participants:
Participants were children with CP (N=32; 53% male; mean age, 9.9y; age range, 4-17y). The majority of participants had a CP diagnosis of quadriplegia (76%) and relied on wheeled mobility (91%).
Interventions:
Assessments were completed pre- and post intrathecal baclofen pump implant.
Main Outcome Measures:
Because of considerable patient heterogeneity, both pain measures (Brief Pain Inventory, Dalhousie Pain Interview) were completed by proxy (parent) report at the time of the procedure and approximately 6 months after intrathecal baclofen (ITB) pump placement.
Results:
Prior to implant, 31% of participants were living with constant pain, which reduced to 6% post ITB implant (P<.001). Based on Wilcoxon signed rank tests, pain duration significantly decreased post ITB pump implant (P<.01).
Conclusions:
This prospective analysis supports the anecdotal and retrospective evidence that musculoskeletal pain decreases in CP following ITB pump implant. The greatest effect appears to be on the duration of pain experience. Pain did not decrease for all individuals, and it would be worth further investigation to better understand the relation between patient characteristics and pain outcomes.
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