Cerebral Palsy and Pain

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Pain is a common symptom of cerebral palsy. Pain can take many different forms, affect different parts of the body, and vary in severity. Treatments for pain include surgery, medications, therapy, and complementary and alternative medicine.

Pain in Children with Cerebral Palsy

Much of the research that has been done regarding pain in general, and specifically addressing pain related to cerebral palsy, has been in adults. Children experience pain, too, but they may respond differently and need to be treated with special consideration and in a different way from adults.

According to a study published by the U.S. National Institutes of Health, which included a study of 2,777 children with cerebral palsy born between 2001 and 2012, “pain constituted a significant problem in children and adolescents with CP.”[1]

Hip pain has been reported as the most common complaint in those with joint and muscle pain. Overly-toned muscles tend to contract, causing spasms. This leads to deformities, misaligned joints, and movement problems that result in pain for children with cerebral palsy.

Other causes of pain are stretching exercises and physical therapy, surgical procedures, and problems related to the use of splints, braces, casts, and other devices.

The Consequences of Pain

Most people understand what it is to have pain, but not all have experienced the kind of chronic pain that a child with cerebral palsy may have to live with indefinitely. There are many consequences of living with chronic pain, especially if it is not addressed or lessened by medication or other treatment strategies.

For a child with pain, life becomes more difficult and limited. A child may not want to move, go out, participate, or even go to bed and sleep because doing these things is difficult with pain or may cause more pain.

Studies have found that children with cerebral palsy experiencing pain are more likely to struggle with anxiety, frustration, and fear. They are at risk of developing depression and withdrawing from everyday activities. Because physical therapy exercises and other treatments for cerebral palsy may cause pain, another consequence is often withdrawal from or lack of interest in therapy.

This can have a serious impact because therapeutic treatment will reduce pain and increase mobility in the long run.

Pain can also affect a child’s behavior. Being in pain frequently may cause a child to lash out, be more aggressive, or avoid school, social situations, and other activities. Relationships can suffer when a child experiences pain, as can the possibility of gaining independence for a child with cerebral palsy. Simply not being able to enjoy life fully is a significant consequence of living with pain.

Managing Cerebral Palsy Pain with Medications

Medications can be one strategy for reducing pain in children with cerebral palsy, although they are not typically used alone. Antispasmodic medications relax over-toned and contracted muscles, which in turn reduces pain.

Anticholinergic drugs also treat muscle spasms, with good results in many cases. Medications that treat gastrointestinal issues may help decrease abdominal complaints, while anti-inflammatories can be used to reduce more generalized pain.[2]

Baclofen is among the most common medications used in children with cerebral palsy. It is an antispasmodic drug that relieves the stiffness that results from muscle contractions and increased muscle tone. It can be given orally or delivered through an implantable pump for more continuous effects.

Surgery comes with its own risks and, at least temporarily, may cause more pain for a child. For many, although the treatment does require an operation, when it is done in combination with medications, it can provide much-needed relief.

Botox and Pain Relief

Botox is botulinum toxin, a substance made from bacteria that can be injected into the body to paralyze specific muscles. The effect is temporary, lasting a few months.

For a child with cerebral palsy, this paralysis relieves the pain associated with spastic, contracted muscles and provides relief for a few months at a time. Physical therapy is usually used along with Botox injections to help improve pain over the long term.

Surgery for Cerebral Palsy Pain

There are many different kinds of surgery that a child with cerebral palsy may undergo. The procedure used depends on the underlying problem causing the pain.

For instance, if a hip problem is severe and other interventions do not help, a surgeon can manipulate the joint to bring it into better alignment, allowing relief from the pain and improved function.[3]

After recovery from the procedure and physical therapy, the child should have a better opportunity to move and walk in a manner that causes less pain.

An extreme but sometimes necessary procedure for relieving pain is called a selective dorsal rhizotomy. It involves severing nerves that are overactive. This surgery is only used to relieve pain when other options, including other surgical procedures, have been tried and have failed to help.

Many of the musculoskeletal complications of cerebral palsy have the potential to cause pain and may be treated successfully with surgery.

Other Ways to Manage Cerebral Palsy Pain

Physical therapy is a commonly used treatment for the mobility and movement issues associated with cerebral palsy.[4] It can occasionally be a source of additional pain, but therapy can lessen pain over time. It has the potential to do this by promoting a range of motion, helping to improve joint alignment, and allowing for more coordination and natural movement that will cause less damage and less pain.

Other strategies to help relieve pain include muscle massage, acupuncture, ice packs and heat therapy, hydrotherapy, and cognitive behavioral therapy.

For a child with any movement restriction, proper positioning can play a very large role. This is a significant contribution that physical therapy brings to treating pain in children with cerebral palsy. An example of this would be in addressing sleep problems.

Learning how to position a child in bed properly can make a big difference in reducing pain during sleep and achieving better quality sleep. This may mean using special equipment to support the child in the best position or simply learning which position works best to reduce pain and allow for more restful sleep.

Addressing, evaluating, managing, and treating pain is essential for children with cerebral palsy. Pain is among the most common complications associated with cerebral palsy, and more research is needed to develop new modalities to improve the quality of life for these children.

As the parent of a child with cerebral palsy, you must listen to your child and find out when and how she experiences pain. With the assistance of both the medical and therapy teams, you can determine which strategies and treatments are most effective for reducing pain and helping them to live a more comfortable and fulfilling life.