Abstract
BackgroundChildren with cerebral palsy (CP) frequently experience chronic pain. The burden and severity of such pain is often underestimated in relation to their other impairments. Recognition and awareness of this chronic pain among children with CP constitute the cornerstone for caretakers and clinicians to improve the quality of life of those children. This study aimed to determine the prevalence of chronic pain among children with CP, and the factors associated.MethodsA cross-sectional study of children with CP, aged 2–12 years, attending the CP rehabilitation clinic and Pediatric Neurology Clinic at Mulago Hospital, Uganda from November 2017 to May 2018. A detailed history and clinical examination were performed and the co-morbidities were determined. CP was classified using the Gross Motor Function Classification System (GMFCS), Manual Ability Classification System, Communication Function Classification System (CFCS), and the Eating and Drinking Ability Classification System (EDACS) and documented with the level of impairment in the different domains. Pain was assessed by using the revised Face, Legs, Activity, Consolability, Cry pain scale.ResultsA total of 224 children with CP were enrolled. The prevalence of chronic pain was 64.3%. The majority had spastic bilateral CP (77.8%), moderate pain lasting over 6 months, and none of them was on long-term pain management. Epilepsy (60.9%), behavioral problem (63.2%), hearing impairment (66,7%), learning problem (67,6%), dental caries (75%), gastro-esophageal reflux (75%), sleep disorders (79.5%), vision impairment (80%), and malnutrition (90%) were co- morbid conditions of chronic pain in children with CP in this study. The factors independently associated with chronic pain among children with CP were the GMFCS level IV & V, CFCS level IV & V, EDACS level IV & V, female children, and caretaker aged more than 30 years.ConclusionsTwo-thirds of children with CP attending rehabilitation in this hospital had chronic pain. None was receiving pain management. Chronic pain was associated with the presence of multiple co-morbidities and more severe disability. Rehabilitation and care programs for children with CP should include assessment of pain in routine care and provide interventions for pain relief in children with CP even at an early age.
Highlights
Children with cerebral palsy (CP) frequently experience chronic pain
Participants with Gross Motor Function Classification System (GMFCS),manual ability classification system (MACS),Classification System (CFCS),eating and drinking ability classification system (EADACS) level IV,V had the highest prevalence of pain in this study;these findings are concurring with a previous cross-sectional multicentre European study done by Gibson et al in 2009 that reported a higher frequency and severity of pain commonly found if the child is more severely impaired in terms of walking ability,hand function,feeding and communication difficulties, intellect and severe type of CP [2]
Another study done in Sweden in 2017 by Lena et al indicated that children with CP with Level V in both Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS) were associated with the highest prevalence of pain and level I
Summary
Children with cerebral palsy (CP) frequently experience chronic pain. The burden and severity of such pain is often underestimated in relation to their other impairments. Children with CP who experience pain are more likely to struggle with anxiety, frustration,fear,depression, and behavior disorders such as aggression [3].Self-report is considered the gold standard for pain assessment due to pain’s subjective and individual in nature; this is challenging for children with CP because some have a speech impairment, which makes it difficult to communicate their experience and others have such severe cognitive impairment that proxy reports are necessary [4]. Recognition and awareness of chronic pain and the burden of associated factors of this pain among children with CP could help us to provide an accurate assessment, and plan for better interventions to improve the quality of life of those children. The study aimed to determine the prevalence of chronic pain in children with CP, to describe the severity and Co- morbidities of pain, and determine the factors associated with such pain
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