Risk factors for pain in children with severe cognitive impairments

Abstract

Diagnosing cause of pain in children with severe cognitive impairments is difficult due to their problems with communication. Identification of risk factors for specific pain etiologies might help professionals in this task. The aim of this study was to determine whether child-related characteristics increase risk for specific types of pain. Participants were the caregivers of 41 females and 53 males with moderate to profound mental retardation, who were aged 3 to 18 years 8 months (mean 10:1, SD 4:4) but who communicated at the level of a typical child of 13.8 months (SD 10 months): 44 of the children had cerebral palsy (CP) and 59 a seizure disorder. Caregivers reported the cause of children's episodes of pain for four 1-week periods over 1 year. Logistic regression analyses were used to predict occurrence of specific types of pain using children's demographic, medical, and physical characteristics. Children had 406 episodes of pain due to accident, gastrointestinal conditions, musculoskeletal problems, infection, recurrent conditions, and common childhood causes. Results indicated that a unique set of risk factors predicted each pain type in this sample. Significant risk factors for pain included: lack of visual impairment and leg impairment (accidental pain); seizures, leg impairment, and greater number of medications (non-accidental pain); being male and tube fed (musculoskeletal pain); age <7 years, absence of CP, visual impairment, and less frequent medical monitoring (infection pain); being female and with arm impairment (gastrointestinal pain); and being tube fed and taking fewer medications (common childhood pains). In most cases, models were more specific than sensitive, indicating that the significant predictors are more useful for eliminating potential pain causes. These results suggest that population risk factors may be helpful in structuring diagnostic investigations for individual children with severe cognitive impairments.

Parent-proxy Ratings of Pain Before and After Botulinum Toxin Type A Treatment for Children With Spasticity and Cerebral Palsy

“…The DPS has been used successfully in previous descriptive studies relying on parent report of pediatric pain and developmental disability including CP. 11,13 The DPS took approximately 10 minutes to complete.…”

“…Because some children had pain more than once on a specific day or, in some cases, had pain that lasted longer than a day, ''episode'' was used as the unit of analysis and defined as one continuous period of pain. 11,13 Data were analyzed with summary level descriptive statistics for each interview and were averaged across participants for items from the DPI (eg, parent-reported frequency) and the BPI (item scores, composite score). A 1-sample test of proportions was used to compare pre-Btx/ A and post-Btx/A parent-reported pain to test the hypothesis that there would be a reduction in reported pain after Btx/A injection.…”

Parents’ experience of pain in children with cerebral palsy and multiple disabilities – An interview study

“…Biological emotions fulfil a survival function and are displayed automatically as facial gestures (14). Evaluating pain (3) and diagnosing the source of pain in children with severe neurological impairment is difficult (5,18). The parents' descriptions of expressed pain match very well with the expression of pain in earlier studies (19,20).…”

Postoperative pain assessment in special patient groups

“…B. auf Schmerzen meist langsamer und anders als gesunde Gleichaltrige [6]. Die eingeschränkte oder fehlende verbale Kommunikation ist aber eine der wichtigsten Hürden auf dem Weg zu einer qualitativ hochwertigen medizinischen Versorgung [7,8,9,10] …”

“…Pain · Pain measurement · Pain assessment · Child · Mental retardation Eine oft eingeschränkte Kommunikation und Individualität der Ausdrucksweise dieser Patienten erschweren aber die Schmerzerfassung und damit eine adäquate Schmerztherapie [7,12,26,27].…”