Parental Pain Catastrophizing, Communication Ability, and Post-surgical Pain Outcomes Following Intrathecal Baclofen Implant Surgery for Patients With Cerebral Palsy.

Breanne J Byiers,Alyssa M Merbler,Chantel C Burkitt,Kenneth D Craig,Caroline L Roberts,Frank J Symons

doi:10.3389/fpain.2021.809351

Abstract

There is strong evidence that psychosocial variables, including pain catastrophizing, influence parental and child ratings of pain, pain expression, and long-term outcomes among children with chronic pain. The role of these factors among children who have communication deficits due to cerebral palsy (CP) and other intellectual and developmental disabilities is currently unclear. In this study, parental pain catastrophizing was assessed before intrathecal baclofen (ITB) pump implantation for spasticity management in 40 children and adolescents with CP, aged 4 to 24 years. Pain was assessed before and after surgery with two methods: a parent-reported pain interference scale, and behavioral pain signs during a standardized range of motion exam. Linear mixed models with clinical/demographic factors and scores from the Pain Catastrophizing Scale for Parents (PCS-P), and child spoken language ability as predictors and the pain variables as the outcomes were implemented. On average, both pain outcomes improved after surgery. Only child spoken language ability predicted change in behavioral reactivity scores, with children with phrase speech showing an increase in reactivity at follow-up compared to pre-surgery levels, on average. A significant interaction between PCS-P scores and spoken language ability on change in pain interference scores over time showed that dyads with children with phrase speech whose parents reported high PCS-P scores reported the least improvement in pain interference at follow-up. Due to the preliminary nature of the study, future work is needed to investigate the parental behaviors that mediate the relationships between parental catastrophizing and pain outcomes in this population.

Highlights

For children with complex communication needs resulting from intellectual and developmental disabilities (IDD) such as cerebral palsy (CP), parents play an essential role with regard to pain assessment and treatment
The Social Communication Model of Pain posits that the experience and expression of pain is the result of an integration of various biological, social, and psychological factors at the intrapersonal and interpersonal levels, involving not just the person experiencing pain, and others present in the environment [6, 7]
No significant differences were found by spoken language ability for child age or sex, parental educational attainment, race, or Pain Catastrophizing Scale for Parents (PCS-P), or pain interference scores

Summary

Introduction

For children with complex communication needs resulting from intellectual and developmental disabilities (IDD) such as cerebral palsy (CP), parents play an essential role with regard to pain assessment and treatment. Parents and other primary caregivers are the most appropriate proxies for judging pain in children with IDD in most cases, many factors can influence both pain expression on the part of the child and judgements about the presence or severity of pain on the part of the caregiver. The Social Communication Model of Pain posits that the experience and expression of pain is the result of an integration of various biological, social, and psychological factors at the intrapersonal and interpersonal levels, involving not just the person experiencing pain, and others present in the environment [6, 7]. The model suggests that pain is not a simple biological construct, but a multifaceted dynamic process that is shaped by an individual’s history and social environment

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Conclusion