Chronic pain, fatigue, and depressive symptoms in adults with spastic bilateral cerebral palsy

Abstract

AIM To investigate the prevalence and co-occurrence of chronic pain, fatigue, and depressive symptoms in adults with spastic bilateral cerebral palsy (SBCP) and explore associations of chronic pain and fatigue with depressive symptoms and daily functioning.METHOD Fifty-six adults with SBCP without severe cognitive impairment participated (35 males, 21 females; mean age 36y 5mo, SD 5y 10mo; Gross Motor Function Classification System level I [13], II [28], III [11], IV [4]). Chronic pain (>3mo), severity and nature of fatigue (Fatigue Severity Scale; Multidimensional Fatigue Inventory), and depressive symptoms (Center for Epidemiological Studies Depression Scale) were assessed. Associations were explored using multivariable logistic regression analyses. RESULTSThe study sample had a higher prevalence of chronic pain (75% vs 39%; p<0.001), mean fatigue (Fatigue Severity Scale, 4.4 [SD 1.3] vs 2.9 [SD 1.1]; p<0.001), and prevalence of depressive symptoms (25% vs 12%; p=0.004) than Dutch healthy reference samples. Chronic pain and severe fatigue co-occurred in 34% and in combination with depressive symptoms in 16% of the participants. Severity of fatigue was associated with depressive symptoms (OR 3.38; p<0.01). Chronic pain and fatigue were not associated with limitations in daily functioning.INTERPRETATION These findings suggest that adults with SBCP are severely affected by chronic pain, fatigue, and depressive symptoms, in addition to their spastic paresis.Pain and fatigue are common symptoms in adults with cerebral palsy (CP). [1][2][3][4] In CP, pain often begins at an early age and frequently becomes a chronic condition. 1,2,4 At least 67% of adults with CP in the USA experience chronic pain. 4 Fatigue is a well-known symptom in various neurological disorders, but is rarely studied in CP. 3,5,6 In a Norwegian study 3,7 the prevalence of fatigue was higher in adults with CP (30%) than in the general population (22%).Pain and fatigue are also common symptoms in the general population 8,9 and often co-occur, especially when they are severe. 8 In the general population, pain and fatigue have been shown to have an impact on daily activities 9 and to be associated with psychological distress, negative mood, and depression. 8,10 For the impact of pain and fatigue on daily activities in CP, Schwartz et al. 4 found that adults with CP tended to report only minor interference from pain on their activity level and social or work functioning, whereas Jahnsen et al.2,3 demonstrated that one-third of their CP sample reported a moderate to extreme impact of pain in daily life and an association of fatigue with limitations due to physical health problems. In a study among children with CP, pain and fatigue were associated with lowered school functioning and, in some cases, partly explained the association between severity of CP and performance at school. 5 Very little has been reported about depression in adults with CP. Jensen et al. 11 found that in adults with CP experiencing chronic pain at least 42% had depressive symp...

Relationship Between Botulinum Toxin, Spasticity, and Pain: a Survey of Patient Perception

“…Likewise, our data in patients with spasticity concurs with previous studies that reported prevalence of pain in stroke to be 19-75%, [26][27][28] 53% in MS, 29 64.9% in SCI 30 and 70% in brain injured patients. 31 The Cochrane Collaboration Systematic Review 32 reported a decrease in shoulder pain after injection of BoNTA; but in contrast, our study provides data on the prevalence of pain at any site in the body (not limited to shoulder pain) in patients experiencing spasticity due to various etiologies.…”

“…Previous multicenter studies have shown the prevalence of pain in the CP population to be 75-80% 26,27 which is similar to the prevalence of 87% in CP patients with spasticity found in the current study. Likewise, our data in patients with spasticity concurs with previous studies that reported prevalence of pain in stroke to be 19-75%, [26][27][28] 53% in MS, 29 64.9% in SCI 30 and 70% in brain injured patients.…”

Pain in children and adolescents with cerebral palsy: a population‐based registry study

“…This may have resulted in a higher prevalence than the level found in our study. Some of the other studies focused on specific types of pain, such as musculoskeletal pain 8, or included specific subtypes of CP, for example bilateral spastic 16, both of which could influence the prevalence rate. Furthermore, we included a wide age span, one to 14 years of age, whereas the other studies focused more on pain in adolescents with CP 6.…”

Time to take notice: what about fatigue?

“…2 In a recent qualitative study, individuals with CP described difficulty with predicting and managing fatigue from activities of daily living such as walking. 3 When this is combined with other literature that demonstrates individuals with CP experience more fatigue than the general population, 4 the question that arises is: 'Do we know how active these individuals need to be in order to gain appropriate health benefits while mitigating the negative consequences of pain and fatigue?' This question remains unanswered, partially due to the fact that most activities of daily living for these individuals result in increased energy expenditure and effort.…”

“…2 Fatigue is not unique to children; adults with spastic diplegic CP report significantly higher levels of fatigue and pain than unaffected adults. 3 Maher et al 4 are the first to describe self-reported fatigue in ambulatory children with physical disabilities, so that comparisons can be made with typically developing children and children with other chronic health conditions. By documenting that fatigue levels in a diverse group of young people with physical disabilities are similar to levels in young people with cancer, this study argues that it is time to pay attention to fatigue in children with physical disabilities, and to address this fatigue directly or indirectly by modifying pain, sleep, or physical activity.…”