Evidence-Based Classification, Assessment, and Management of Pain in Children with Cerebral Palsy: A Structured...

Background and objectives: Pain is a prevalent and often underestimated issue in children with cerebral palsy (CP). When left untreated, pain can result in secondary complications such as reduced mobility and mental health challenges, which negatively impact social activity, participation, and overall quality of life. This review explores the complex mechanisms underlying pain in CP, highlights contributing factors, and places particular emphasis on diagnostic challenges and multimodal pain management strategies. Methods: Three scientific databases and, additionally, guideline repositories (2015-2025) were searched, yielding 1335 records. Following a two-step deduplication process, 850 unique items remained. Eighty-five full texts were assessed, of which 49 studies were included. These comprised one randomised controlled trial, 16 non-randomised studies, 12 systematic reviews, 8 non-systematic reviews, and 12 guidelines or consensus statements. Methodological quality was appraised with AMSTAR-2 where applicable, and Oxford levels of evidence were assigned to all studies. Results: Study quality was variable: 25% were systematic reviews, with only one randomised controlled trial. This literature identifies overlapping nociceptive, neuropathic, and nociplastic mechanisms of pain development. Classification remains inconsistent, though the International Classification of Diseases provides a useful framework. Only five assessment tools have been validated for this population. Interventions were reported in 45% of studies, predominantly pharmacological (27%) and physiotherapeutic (23%). Evidence gaps remain substantial. Conclusions: This review highlights the complexity of pain in children and adolescents with cerebral palsy and the need for a biopsychosocial approach to assessment and management. Evidence supports individualised, multimodal strategies integrating physical therapies, contextual supports, and, where appropriate, medical or surgical interventions. Clinical implementation remains inconsistent due to limited high-quality evidence, inadequate assessment tools, and poor interdisciplinary integration.