Abstract
Chronic pain is prevalent in adults with cerebral palsy. We aimed to explore associations between chronic pain and somatosensory, motor, cognitive, etiologic, and environmental factors in adults with cerebral palsy. This cross-sectional study enrolled 17 adult participants with cerebral palsy (mean age 31 years; 8 female; Gross Motor Functional Classification Status levels I-V) able to self-report and 10 neurotypical adult volunteers (mean age 34 years; 9 female). Participants reported pain characteristics, demographics, and affective factors. Physical examination included somatosensory and motor evaluation. Between-group comparisons used a ranksum test, and correlation analyses estimated effect size in terms of shared variance (ρ2). Individuals with cerebral palsy reported greater pain intensity, neuropathic qualities, and nociceptive qualities than control participants. Higher pain intensity was associated with female gender (ρ2 = 16%), anxiety/depression symptoms (ρ2 = 10%), and lower household income (ρ2 = 19%). It was also associated with better communicative ability (ρ2 = 21%), spinothalamic (sharp/temperature) sensory abnormalities (ρ2 = 33%), and a greater degree of prematurity (ρ2 = 17%). This study highlights similarity of chronic pain associations in people with cerebral palsy with patterns seen in other populations with chronic pain. Spinothalamic sensory abnormalities suggest central pain mechanisms.
Highlights
Chronic pain is reported in 2/3 of adults with cerebral palsy (CP) and is recognized as a major factor impacting quality of life [1]
We aimed to identify clinical factors associated with specific chronic pain characteristics in communicative adults with CP
Basal ganglia/thalamic injury were associated with term birth (ρ·|ρ| = +0.33); additional associations outside of those reported for gestational age include higher dystonia scores (ρ·|ρ| = +0.48) and tactile discrimination deficits (ρ·|ρ| = +0.33; Figure 3). In this preliminary investigation of adults with CP, our data supports the established finding that chronic pain is prominent in this population and that it can have substantive effects on quality of life [1]
Summary
Chronic pain is reported in 2/3 of adults with cerebral palsy (CP) and is recognized as a major factor impacting quality of life [1]. While motor impairment is a defining characteristic of CP, there is converging evidence that the underlying etiology of chronic pain extends beyond musculoskeletal pathology. Musculoskeletal pain would be expected to elicit nociceptive pain descriptors (“sore,” “achy,” or “tender”), yet a substantial subset of individuals with CP report neuropathic pain qualities (“sharp,” “burning,” or “stabbing”) [3]. Supporting the concept of neuropathic pain, somatosensory abnormalities are prevalent in individuals with CP. Quantitative sensory testing (QST) in children with CP often shows mechanical and thermal hypoaesthesia as well as mechanical hyperalgesia [4]. The pattern of sensory abnormalities may shift over the lifespan [5]
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