Data linkage and pain medication in people with cerebral palsy: a cross‐sectional study

Abstract

Aim To explore data linkage and pain medication as a proxy for pain, to assess differences in pain medication between the cerebral palsy (CP) and the general populations, and to identify factors associated with pain medication in CP. Method This cross‐sectional study linked the Northern Ireland CP Register and two administrative health care databases for people resident in Northern Ireland born between 1981 and 2008. Pain medication as a proxy was validated by replicating analyses from the Study of Participation of Children with Cerebral Palsy Living in Europe (SPARCLE) studies. Logistic regression compared pain medication in the CP and general populations. Multi‐level regression models assessed factors associated with pain medication in the CP cohort. Results The sample size was 701 075, of whom 1430 (0.2%) were people with CP. There were 358 969 males and 340 677 females in the general population, and 810 males and 620 females in the CP population, with an age range of 4 to 31 years in both groups. The validation exercise produced results similar to the SPARCLE studies. More people with CP received pain medication (61% vs 50.9%) and had twice the odds of being prescribed opioid analgesics (odds ratio [OR]=2.81, 95% confidence interval [CI] 2.32–3.40). Among those with CP, the odds of being prescribed pain medication were higher for: females (OR=1.34, 95% CI 1.06–1.70), younger age (OR=1.60, 95% CI 1.02–2.51), Gross Motor Function Classification System level V (OR=2.60, 95% CI 1.52–4.47), seizures (OR=2.55, 95% CI 1.68–3.87), and higher deprivation score (OR=2.06, 95% CI 1.41–3.24). Interpretation Pain medication is an effective proxy for pain. More people with CP were prescribed pain medication than the general population. Pain medication for people with CP is not only dependent on physiological and clinical characteristics, but also environmental factors. Data linkage using pain medication as a proxy for experiencing pain is a valid method. People with cerebral palsy (CP) are more likely to experience pain than the general population. People with CP have over twice the odds of receiving opioids compared to the general population. The odds of being prescribed pain medication were higher for females with CP. Prescription of pain medication among those with CP is not only dependent on clinical characteristics, but also environmental factors.

Enhanced nociceptive behavior and expansion of associated primary afferents in a rabbit model of cerebral palsy

“…Chronic pain is the most prevalent comorbidity of CP (McDowell et al, 2017; Novak et al, 2012): up to 77% of children with CP experience pain (McKinnon et al, 2018, 2020). Individuals with CP experience chronic pain at significantly higher rates than the rest of the population (Badia et al, 2014; Doralp & Bartlett, 2010; García Jalón et al, 2021; Westbom et al, 2017). Pain decreases quality of life (Findlay et al, 2016), yet the pathophysiology of pain is rarely researched in the context of CP.…”

“…This is likely due to the pervasive view that pain in individuals with CP is a symptom arising from secondary effects of physical stressors, including spasticity, hip subluxation, and joint contractures. Individuals with severe CP (as measured by gross motor function classification system [GMFCS] V) do experience more pain (García Jalón et al, 2021; McKinnon et al, 2018); however, CP‐affected individuals across all GMFCS levels report pain (Flanigan et al, 2020; Sienko, 2018). Even individuals born very prematurely (<26 weeks' gestation), who do not develop CP, report recurrent pain and altered thermal sensitivity as adults (Walker et al, 2018).…”

Enhanced nociceptive behavior and expansion of associated primary afferents in a rabbit model of cerebral palsy

“…Chronic pain is the most prevalent co-morbidity of CP (McDowell et al, 2017; Novak et al, 2012): up to 77% of children with CP experience pain (McKinnon et al, 2020; Mckinnon et al, 2018). Individuals with CP experience chronic pain at significantly higher rates than the rest of the population (Badia et al, 2014; Doralp and Bartlett, 2010; García Jalón et al, 2021; Westbom et al, 2017). Pain decreases quality of life (Findlay et al, 2016), yet the pathophysiology of pain is rarely researched in the context of CP.…”

“…This is likely due to the pervasive view that pain in individuals with CP is a symptom arising from secondary effects of physical stressors, including spasticity, hip subluxation, and joint contractures. Individuals with severe CP (as measured by Gross Motor Function Classification System (GMFCS) V) do experience more pain (García Jalón et al, 2021; Mckinnon et al, 2018); however, CP-affected individuals across all GMFCS levels report pain (Flanigan et al, 2020; Sienko, 2018). Even individuals born very prematurely (<26 weeks gestion), who do not develop CP, report recurrent pain and altered thermal sensitivity as adults (Walker et al, 2018).…”

Cerebral palsy and the data of pain

“…4 Garcia Jalon et al's research is significant in identifying pain prescription as a proxy for pain. 5 Without claiming, of course, that it is comprehensive or an adequate diagnostic marker, this proxy is a valuable analytical tool that opens the door to future large-scale, population-based studies. Such studies are clearly needed given the prevalence of pain in people with CP.…”