Pathophysiology of chronic pain in cerebral palsy: implications for pharmacological treatment and research

Blackman, James A.; Svensson, Camilla I.; Marchand, Serge

doi:10.1111/dmcn.13930

Cited by 45 publications

(53 citation statements)

References 57 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Recognition is only half the battle. As stated by Blackman et al, recognition of pain is step one in our understanding of its underlying pathophysiology in young people with CP. In turn this may aid us in focusing on appropriate and potentially novel ways of pharmacological and therapeutic intervention to enable comfort and function.…”

Section: Discussionmentioning

confidence: 99%

“…We were interested in what treatments individuals use to control pain, because Westbom et al found that in clinical practice, although structured assessments had captured the presence of pain, very little intervention was recorded in the notes of the young people. The implications of pharmacological treatment in chronic pain in CP were also highlighted in the recent review on pathophysiology by Blackman et al To address these questions, we report the presence, severity, timing, site, impact, associated features, and self‐management of pain in a cross‐sectional study of a population‐based cohort of young people with bilateral CP.…”

mentioning

confidence: 97%

See 1 more Smart Citation

Factors associated with pain in adolescents with bilateral cerebral palsy

Fairhurst

Shortland

Chandler

et al. 2018

Develop Med Child Neuro

View full text Add to dashboard Cite

Aim We explored factors associated with pain and its severity in a population cohort of young people with bilateral cerebral palsy, comparing parent/carer and young people self‐reports. Method Of 278 survivors (mean age 16y 8mo, SD 1y 4mo, range 13y 8mo–19y 3mo) from the South Thames in the Study of Hips and Physical Experience cohort of 338 young people with bilateral cerebral palsy, 212 parents/carers and 153 young people completed questionnaires on the presence, severity, timing, site, associated factors, impact, and treatment of pain. Results Seventy per cent of parents/carers reported pain within 3 months, 59% the previous week, and 50% the previous day with 56% reporting ‘regularly experienced’. Of young people able to do so, 63% reported pain within 3 months, 50% the previous week, and 42% the previous day, with 48% reporting regular pain. There was strong agreement between the parent/carer and young people, reporting pain severity over the previous 3 months. Pain severity was associated with increased motor impairment and comorbidity, particularly constipation, spasticity, equipment use, and higher emotional score, but not sex, intellectual disability, speech, or maternal education. Multiple sites of musculoskeletal pain were reported in two‐thirds of individuals. Pain was associated with voluntary movement in individuals with less motor impairment and with being moved in those with severe motor impairment. Greater pain severity had a negative effect on both physical and psychological quality of life. Interpretation Increasing awareness of the comorbidities in cerebral palsy may aid effective treatment, reducing pain experienced by young people with cerebral palsy. What this study adds Regular moderate or severe pain is reported in young people with bilateral cerebral palsy (CP) in all Gross Motor Function Classification System levels. Pain is reported more frequently in young people who are non‐ambulant. General ill health is strongly associated with severity of pain after controlling for severity of CP, especially constipation. Pain occurs most often in ambulant young people during voluntary activity and in those who are non‐ambulant when being moved. There is strong agreement between parents/carers and young people about pain presence and severity.

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 97%

Factors associated with pain in adolescents with bilateral cerebral palsy

Fairhurst

Shortland

Chandler

et al. 2018

Develop Med Child Neuro

View full text Add to dashboard Cite

show abstract

“…The studies we have identified are mainly focused on nociceptive mechanisms and primarily in the musculoskeletal system. Chronic pain in CP is, however, complex and heterogeneous, involving multiple inhibitory and excitatory mechanisms in the peripheral and central nervous systems that may serve to increase pain experience or conversely offer potential targets for treatment . We identified no studies that examined treatment targeted to central pain excitatory mechanisms such as central sensitization, and suggest that these would be a valuable focus for future research.…”

Section: Discussionmentioning

confidence: 99%

“…We identified no studies that examined treatment targeted to central pain excitatory mechanisms such as central sensitization, and suggest that these would be a valuable focus for future research. Affective mechanisms are also important in the maintenance of chronic pain conditions and in their treatment …”

Section: Discussionmentioning

confidence: 99%

Management of pain in children and adolescents with cerebral palsy: a systematic review

Ostojic

Paget

Morrow

2018

Develop Med Child Neuro

View full text Add to dashboard Cite

ABBREVIATIONS BoNT-A Intramuscular botulinum toxin-A VAS Visual analogue scale ITB Intrathecal baclofen AIM To determine the efficacy of interventions for the management of pain in children and adolescents with cerebral palsy (CP). METHOD Electronic databases were searched from the earliest date possible to April 2018 using a mixture of subject headings and free text. Inclusion criteria comprised of studies with (1) diagnosis of CP, (2) under the age of 18 years, (3) intervention for the management of pain, (4) outcome measure of pain, and (5) studies published in English-language peerreviewed journals. RESULTS Fifty-seven studies met the eligibility criteria. Pain related to (n=number of studies): hypertonia (n=17), spastic hip disease (n=13), procedures for the management of CP (n=7), postoperative (n=18), and other (n=2). Most of the studies were of level III to level V evidence.

show abstract

“…surgery) interventional management, general health conditions (e.g. headaches, period pain), and other CP related comorbidities [10,11]. CP related comorbidities are characteristically high in predominant dyskinetic subtypes, and may include scoliosis, hip displacement, muscle contracture, gastrointestinal dysfunction, and the dyskinetic movement disorder itself [10,12,13].…”

mentioning

confidence: 99%

The lived experience of chronic pain and dyskinesia in children and adolescents with cerebral palsy

et al. 2020

View full text Add to dashboard Cite

Background: To explore the lived experience of chronic pain and dyskinesia in children and adolescents with cerebral palsy. Methods: A convergent parallel mixed methods design was undertaken. First, a quantitative cross-sectional study of participants able to self-report their quality of life was undertaken. This study characterised pain chronicity, intensity, body locations, and quality of life. Second, semi-structured interviews were undertaken with a subset of children and adolescents experiencing chronic pain. Results: Twenty-five children and adolescents took part in the cross-sectional study, 23 of whom experienced chronic pain and 13 of moderate intensity. Pain was often located in multiple bodily regions (6/21), with no trends in quality of life outcomes detected. Eight participated in semi-structured interviews, which identified three key themes including 'lives embedded with dyskinesia', 'real world challenges of chronic pain', and 'still learning strategies to manage their pain and dyskinesia'. Conclusions: A high proportion of children and adolescents with cerebral palsy and dyskinesia who were able to self-report experienced chronic pain. The physical and emotional impacts of living with chronic pain and dyskinesia existed along a spectrum, from those with lesser to greater extent of their impacts. Children and adolescents may benefit from targeted chronic pain education and management within bio-psychosocial models.

show abstract

Pathophysiology of chronic pain in cerebral palsy: implications for pharmacological treatment and research

Abstract: Pain conditions in cerebral palsy have differing mechanisms and will not respond to the same treatments. Novel analgesics under development include inhibitors of ion channels, nerve growth factor, and calcitonin gene-related peptide.

Cited by 45 publications

References 57 publications

Factors associated with pain in adolescents with bilateral cerebral palsy

Factors associated with pain in adolescents with bilateral cerebral palsy

Management of pain in children and adolescents with cerebral palsy: a systematic review

The lived experience of chronic pain and dyskinesia in children and adolescents with cerebral palsy

Contact Info

Product

Resources

About