Evaluation of Pain in Adults With Childhood-Onset Disabilities and Communication Difficulties.

Taylor Jersak,Garey Noritz

doi:10.3389/fneur.2021.722971

Abstract

Adults with childhood-onset disabilities, particularly those with central nervous system impairment, commonly experience pain. Because many such individuals have difficulties in communication, caregivers and medical professionals must identify and interpret non-verbal behaviors as indicators of pain. This process is challenging and can lead to poor outcomes through delayed or incorrect diagnosis and treatment. Most research in the evaluation of pain in individuals with neurologic impairment has focused on the pediatric population, and evidence-based guidelines do not exist for adults. The purpose of this paper is to review current recommendations for pain assessment in adults with communication impairment. This approach includes guidance for history-taking, pharmacologic review, physical examination, and the judicious use of laboratory and imaging tests. Finally, we discuss adult-specific diagnoses to consider when evaluating pain in adults with childhood-onset disabilities and communication difficulties.

Highlights

Because of advancements in medicine, people with childhood-onset disabilities commonly live into adulthood [1, 2]
One of the most common childhood-onset disabilities is cerebral palsy (CP), a group of movement disorders caused by a disturbance to the fetal or infant brain [2, 3]
The brain disorder causing cerebral palsy is not progressive, the manifestations of CP can change over time, and this population experiences numerous physical and psychological challenges, such as pain, that can change and persist into adulthood [2, 5, 6]

Summary

Introduction

Because of advancements in medicine, people with childhood-onset disabilities commonly live into adulthood [1, 2]. One of the most common childhood-onset disabilities is cerebral palsy (CP), a group of movement disorders caused by a disturbance to the fetal or infant brain [2, 3]. The brain disorder causing cerebral palsy is not progressive, the manifestations of CP can change over time, and this population experiences numerous physical and psychological challenges, such as pain, that can change and persist into adulthood [2, 5, 6]. In children and young adults with cerebral palsy, prevalence of pain ranges from 14 to 76% [2, 7]. Pain is more common in non-ambulatory adults with cerebral palsy, with a prevalence of 79% [8]

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Conclusion