Pain in Children With Cerebral Palsy: A Review

Abstract and Introduction

Children with cerebral palsy (CP) face many challenges including impaired motor control and coordination, functional impairment, sensory disturbances, and, sometimes, communication difficulties and cognitive deficits. Pain also may be a problem for children with CP due in part to the inherent deficits associated with the disease, as well as the invasive medical and surgical procedures and rehabilitative activities children with CP undergo on a regular basis. A review of current literature indicates pain is a common experience for children with CP and has been understudied in this population. Further emphasis and research on appropriate assessment and management strategies sensitive to the unique characteristics and limitations of children with CP are warranted.

The reduction in mortality rates related to traumatic childbirth and childhood illnesses or injuries, due in part to medical and technological advances, has resulted in an increasing number of children living with physical disabilities. One such physical disability is cerebral palsy (CP). Children with CP face many challenges including impaired motor control and coordination, functional impairment, sensory disturbances and, sometimes, communication difficulties and cognitive deficits. Pain may be a problem for children with CP as a result of the inherent deficits associated with CP, as well as the invasive medical and surgical procedures and rehabilitative activities children with CP undergo on a regular basis. Ironically, the interventions frequently employed to improve motor control and function, modify deformities, reduce pain, and enhance quality of life can actually cause pain or discomfort, at least temporarily (Hadden & von Baeyer, 2002; Nolan, Chalkiadis, Low, Olesch, & Brown, 2000). This article examines issues related to the experience of pain in children with CP by synthesizing current literature. Suggestions for further research and inquiry are provided.

Cite this: Pain in Children With Cerebral Palsy: A Review - Medscape - Oct 01, 2004.

Table 1. Common Potential Contributors to the Experience of Pain in Children with CP
Surgical	Procedural	Gastrointestinal
Selective dorsal rhizotomy Soft tissue releases Tendon lengthening Capsulotomy Fasciotomy Osteotomy Tenotomy Spinal fusion Pump implantation for intrathecal baclofen adminstration Fundoplication Gastrostomy tube placement	Intramuscular and other medication injections Adminstration of anesthesia Blood draws Placement of a nasogastric tube Dental procedures Enemas	Gastroesophageal reflux Nausea/vomiting following surgical procedures Gastrostomy tube-related pain or infection Abdominal pain
Orthopedic	Neuromuscular	Rehabilitative
Hip subluxation/dislocation Cephalad displacement of the patella Equines of the ankle Valgus deformities of the ankle Varus and valgus deformities of the foot Radial subluxation/dislocation Cartilage degeneration scoliosis Pelvic obliquity Kyphosis Ordosis Contractures Degenerative arthritis	Spasticity Overuse syndromes Nerve entrapments Radiculopathies Myelopathies Contractures	Range of motion Home exercise programs Strengthening Electrical stimulation Functional mobility training Participation in activities of daily living Splinting and orthotic fabrication and follow-up Serial casting Training for use of adaptive equipment Utilization of standing frames and other positioning devices

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Pain in Children With Cerebral Palsy: A Review

Abstract and Introduction

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