Pain in persons with cerebral palsy.
01 Oct 1999-Archives of Physical Medicine and Rehabilitation (Elsevier)-Vol. 80, Iss: 10, pp 1243-1246
TL;DR: The data suggest that pain is common in adults with CP, and in many subjects, pain levels were moderate to intense.
About: This article is published in Archives of Physical Medicine and Rehabilitation.The article was published on 1999-10-01. It has received 199 citations till now. The article focuses on the topics: Chronic pain & Back pain.
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TL;DR: This review summarizes key factors that must be considered to support this critical clinical transition and sets the foundation for future research to apply prospective study designs to evaluate transition interventions and determine long-term health outcomes.
241 citations
TL;DR: Musculo-skeletal pain is a pronounced problem in adults with cerebral palsy from an early age, and should be addressed specifically in the follow-up programs, and in further clinical studies on potential causal pathways.
Abstract: Objective: To examine prevalence and localization of musculo-skeletal pain in adults with cerebral palsy compared with the general population and to investigate variables potentially associated with pain. Design: A postal survey. Subjects: Persons with cerebral palsy and no intellectual disabilities, 18 years or more, living in Norway. Methods: A multidimensional questionnaire, including items on musculo-skeletal pain, was sent to 766 adults with cerebral palsy. Results: In total 406 persons responded, 49% females and 51% males age range 18–72 years (mean 34 years). All categories of cerebral palsy were represented. Nearly onethird of the adults with cerebral palsy had chronic pain, vs 15% in the general population. Mean scores of domain of bodily pain on Short Form 36 were significantly lower from an earlier age in adults with cerebral palsy. Back pain was the most common in both groups. Pain in adults with cerebral palsy was significantly associated with gender, chronic fatigue, low life satisfaction and deteriorating physical function. Conclusion: Musculo-skeletal pain is a pronounced problem in adults with cerebral palsy from an early age, and should be addressed specifically in the follow-up programs, and in further clinical studies on potential causal pathways.
227 citations
Cites background or result from "Pain in persons with cerebral palsy..."
...These findings indicate that musculo-skeletal pain is mostly widespread pain, both in the general population and in adults with CP (1, 2, 7, 11)....
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...(11) defined chronic pain as daily pain with duration of 3 months or more, and in their study 56% fulfilled these criteria....
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...Other studies (11, 12) have found low impact of pain on daily life in adults with CP, explained by a floor effect resulting from the already low activity level....
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...The mean number of pain sites in the present study was 3 sites, 4 in women and 3 in men, confirming the results of other studies on both adults with CP and the general population (1, 2, 7, 11)....
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...Regarding pain distribution on body-parts, back pain was most frequently reported, both in the present and other studies on adults with CP (7, 11), and in the general population (1, 2)....
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TL;DR: Routine AADP reduced the number of Rhesus-negative women who were sensitised during pregnancy, and some instances of sensitisation could still occur before or despite administration of A ADP.
Abstract: CRD summary This review assessed routine antenatal anti-D prophylaxis (AADP) for pregnant women who are Rhesus-negative. Routine AADP reduced the number of Rhesus-negative women who were sensitised during pregnancy. Some instances of sensitisation could still occur before or despite administration of AADP. The conclusions appear supported by the evidence presented, though the variable quality of included studies should be noted.
208 citations
TL;DR: Deterioration of locomotion skills is a significant problem in persons with CP from an early age, documenting the need for life-long follow-up and the predictors above should be investigated in further clinical studies.
Abstract: Objectives: To investigate self-reported locomotion skills in persons with cerebral palsy (CP) and to investigate variables potentially associated with deterioration of walking skills.Design: Cross-sectional retrospective survey.Setting and subjects: A multidimensional mailed questionnaire was sent to 766 persons with CP, 18 years or over, without intellectual disabilities, living in Norway.Main outcome measures: The questionnaire consisted of demographic and diagnostic items, items on locomotion skills, and physical function (SF-36).Results: In total 406 persons, 51% males and 49% females from 18 to 72 years (mean 34 years, SD 11 years) with all categories of CP responded. Median age for reported walking debut was 3 years, with a range from 1 to 14 years. In total 216 respondents (53%) walked without support, 104 persons (25%) walked with support, 39 persons (10%) had lost their walking skills, and 47 (12%) had never been able to walk. Mean level of physical function (SF-36) was 53 out of 100. There were...
205 citations
References
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TL;DR: A Guttman scale analysis showed that pain intensity and disability measures formed a reliable hierarchical scale and may be useful when a brief ordinal measure of global pain severity is required.
Abstract: This research develops and evaluates a simple method of grading the severity of chronic pain for use in general population surveys and studies of primary care pain patients Measures of pain intensity, disability, persistence and recency of onset were tested for their ability to grade chronic pain severity in a longitudinal study of primary care back pain (n = 1213), headache (n = 779) and temporomandibular disorder pain (n = 397) patients A Guttman scale analysis showed that pain intensity and disability measures formed a reliable hierarchical scale Pain intensity measures appeared to scale the lower range of global severity while disability measures appeared to scale the upper range of global severity Recency of onset and days in pain in the prior 6 months did not scale with pain intensity or disability Using simple scoring rules, pain severity was graded into 4 hierarchical classes: Grade I, low disability--low intensity; Grade II, low disability--high intensity; Grade III, high disability--moderately limiting; and Grade IV, high disability--severely limiting For each pain site, Chronic Pain Grade measured at baseline showed a highly statistically significant and monotonically increasing relationship with unemployment rate, pain-related functional limitations, depression, fair to poor self-rated health, frequent use of opioid analgesics, and frequent pain-related doctor visits both at baseline and at 1-year follow-up Days in Pain was related to these variables, but not as strongly as Chronic Pain Grade Recent onset cases (first onset within the prior 3 months) did not show differences in psychological and behavioral dysfunction when compared to persons with less recent onset Using longitudinal data from a population-based study (n = 803), Chronic Pain Grade at baseline predicted the presence of pain in the prior 2 weeks Chronic Pain Grade and pain-related functional limitations at 3-year follow-up Grading chronic pain as a function of pain intensity and pain-related disability may be useful when a brief ordinal measure of global pain severity is required Pain persistence, measured by days in pain in a fixed time period, provides useful additional information
2,636 citations
TL;DR: Women with CP residing in the community perceived themselves as healthy, and the observed health status measures support this concept, and independent relationships were found between several of these measures indicating no significant association among the variables.
177 citations
TL;DR: It is demonstrated that in the adult patient with cerebral palsy and scoliosis, a definite correlation exists between deformity size and functional decline and decubiti and progression rate also seems to be a factor in functional decline.
Abstract: Study design Fifty-six residents with cerebral palsy and significant scoliosis or kyphosis at the Hazelwood Center in Louisville, Kentucky were studied periodically using radiographs to assess the degree of scoliosis, kyphosis, and pelvic obliquity and by clinical evaluation to assess functional status and skin condition. Objectives This study followed the natural history of untreated scoliosis to determine whether a decline in functional status is related to curve progression and whether the development of decubiti is associated with the degree of pelvic obliquity. Identifying the factors that affect functional decline may help develop treatment plans to minimize it. Summary of background data Significant structural deformities of the spine often accompany cerebral palsy. Despite the relatively large number of cases, little is known about the natural history of untreated scoliosis in the adult cerebral palsy population. Theoretically, curve progression will lead to pain, loss of ambulation or sitting balance, or even cardiopulmonary compromise, but few studies have been done to verify this. Methods Single-factor analysis of variance was used to compare the curve progression rate within groups based on the structure of the curve, and the two-sample student t test was used to compare the average initial curve, the average final curve, the progression rate, and the amount of progression between groups based on functional decline. The two sample t test also was used to correlate the average pelvic obliquity and the size of the final curve with the presence or absence of decubiti. Results Functionally, 10 patients (18%) declined during the course of the study. In these 10 patients, the average initial curve was 41.1 degrees, the average final curve was 80.6 degrees, and the average progression rate was 4.4 degrees per year. For the stable patients, the average initial curve was 33.9 degrees, the average final curve was 56.5 degrees, and the average progression rate was 3.0 degrees per year. The differences between the final curve and the absolute amount of progression were statistically significant (P = 0.018 and P = 0.03, respectively). Three patients developed decubiti. Their curve averaged 106 degrees, and their pelvic obliquity measured 45 degrees, both of which were significantly higher than those of the patients without decubiti. Conclusions The results of the present study demonstrate that in the adult patient with cerebral palsy and scoliosis, a definite correlation exists between deformity size and functional decline and decubiti. Progression rate also seems to be a factor in functional decline. Additional studies are needed to determine whether surgical intervention will halt or reverse the decline.
140 citations
TL;DR: Through physical, mental, and medicinal modalities that include both opioids and nonopioid options, a more comprehensive treatment plan can provide better pain control while minimizing opioid side effects.
Abstract: The opioid epidemic in the United States has changed how medicine is practiced There are tools and resources available to help the surgeon understand pain and provide appropriate pain management Understanding pain, setting expectations, and diagnosing underlying medical dispositions that can lead to opioid addiction should become standard practice Understanding available tools for communication, setting appropriate expectations, and preoperative planning for postoperative pain will provide better pain control Through physical, mental, and medicinal modalities that include both opioids and nonopioid options, a more comprehensive treatment plan can provide better pain control while minimizing opioid side effects
106 citations
TL;DR: A homogenous population of 37 institutionalized patients with scoliosis and severe cerebral palsy was evaluated to assess the impact of spinal stabilization on comfort, function, health, and ease of nursing care.
Abstract: A homogenous population of 37 institutionalized patients with scoliosis and severe cerebral palsy was evaluated to assess the impact of spinal stabilization on comfort, function, health, and ease of nursing care. Through a prospective care-burden study, a 34-month retrospective analysis, and a healthcare worker questionnaire, 17 fused patients with a mean current scoliosis of 35 degrees were compared with 20 nonfused patients with a mean scoliosis of 76 degrees. No clinically significant differences were noted in pain or pulmonary medication utilization or therapy, decubiti, function, or time for daily care. Nevertheless, the majority of healthcare workers believed that the fused patients were more comfortable.
79 citations