Study flags pain in kids with cerebral palsy

One in four children with cerebral palsy has moderate to severe pain that limits activities, according to a study published yesterday in Pediatrics.

Caregivers filled out a survey and doctors reported the presence and cause of pain in 252 youth aged three to 19 in this Holland Bloorview study.

Hip pain and tight muscles were the most frequent causes of pain “and have specific treatments,” says lead researcher Dr. Darcy Fehlings, physician director of the Child Development Program at Holland Bloorview and clinician senior scientist at the Bloorview Research Institute.

For example, regular hip x-rays can identify partial hip dislocation (called hip subluxation), which can be treated with stretching, hip abduction bracing, Botox and orthopedic surgery, before complete dislocation and chronic pain develop.

“A number of treatments exist for dystonia, ranging from oral medication, [Botox], intrathecal baclofen pumps, and, more recently, deep brain stimulation, to help prevent children from becoming ‘stuck’ in painful postures,” the researchers say.

The main cause of pain in 10 per cent of the children and youth was constipation, which can be effectively treated with the laxative polyethylene glycol.

"This study underlines the importance of asking every child with cerebral palsy about their pain levels," says Dr. Melanie Peller, a fellow in developmental pediatrics at Holland Bloorview. "This can sometimes pose a challenge for children with communication limitations, which makes a systematic pain assessment plan crucial."