Related Experiment Video
Updated: Jan 13, 2026
Author Spotlight: Exploring the Potential of Massage Therapy in Cerebral Palsy Using Animal Models
Published on: August 11, 2023
Evidence-Based Classification, Assessment, and Management of Pain in Children with Cerebral Palsy: A Structured
Anna Gogola1,2, Rafał Gnat1,2
1Institute of Physiotherapy and Health Sciences, Academy of Physical Education, 40-065 Katowice, Poland.
Insights
Pain in children with cerebral palsy (CP) is complex, requiring a biopsychosocial approach. Individualized, multimodal strategies integrating physical therapies and supports are recommended, but clinical implementation faces challenges due to limited evidence.
Area of Science:
- Pediatric Pain Management
- Cerebral Palsy Research
- Biopsychosocial Health
Background:
- Pain is a significant, often overlooked issue in children with cerebral palsy (CP).
- Untreated pain can lead to reduced mobility, mental health issues, and decreased quality of life.
- Understanding pain mechanisms, contributing factors, and diagnostic challenges in CP is crucial.
Purpose of the Study:
- To review the complex mechanisms of pain in CP.
- To highlight factors contributing to pain in this population.
- To emphasize diagnostic challenges and multimodal pain management strategies.
Main Methods:
- Searched three databases and guideline repositories (2015-2025).
- Included 49 studies (reviews, guidelines, limited RCTs) after initial screening of 1335 records.
- Assessed methodological quality using AMSTAR-2 and Oxford levels of evidence.
Main Results:
- Identified overlapping nociceptive, neuropathic, and nociplastic pain mechanisms.
- Found inconsistent pain classification and limited validated assessment tools (only five).
- Interventions primarily involved pharmacological (27%) and physiotherapeutic (23%) approaches, with substantial evidence gaps.
Conclusions:
- Pain in children and adolescents with CP is complex, necessitating a biopsychosocial approach.
- Individualized, multimodal strategies combining physical therapies, contextual supports, and medical/surgical interventions are supported.
- Clinical implementation is hindered by limited high-quality evidence, inadequate assessment tools, and poor interdisciplinary integration.
Abstract:
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.
