Cerebral Palsy and Pain
This article has been fact checked by a Board Certified Pediatrician. Sources of information for the article are listed at the bottom.
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Of the many conditions that can be associated with cerebral palsy, one of the most common is pain. Pain can take many different forms, affect different parts of the body, and vary in severity by the individual. What the types of pain associated with cerebral palsy have in common is that they all cause a person to be uncomfortable and restrict movement and activities, including sleep.
The consequences of living with pain revolve around living a limited life. When a child or adult with cerebral palsy is in pain most of the time, it is difficult to do anything or to enjoy daily life. There are many ways in which pain can be treated, from surgery to help correct orthopedic issues to the use of painkillers. Coping with pain may involve many strategies, but it is an important aspect of living with cerebral palsy.
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, therefore, need to be treated with special consideration and in a different way from adults.
Studies have found that up to 84 percent of adults with cerebral palsy experience pain and that as many as half of those feel pain every day. Some research has also emerged that focused on children with both cerebral palsy and pain.
One study surveyed 20 children living with cerebral palsy and found that 70 percent of them reported experiencing pain, and 64 percent described the pain as a real problem for them. The spastic form of cerebral palsy, characterized by increased muscle tone, generally seems to cause more pain than other types.
This is because the overly-toned muscles tend to contract, causing spasms, and this leads to deformities, misaligned joints, and movement problems that result in pain. Hip pain has been reported as the most common complaint in those with joint and muscle pain.
Another issue is gastrointestinal pain. A study of 58 children with cerebral palsy found that almost all of them suffered from gastrointestinal distress and that 32 percent had experienced abdominal pain.
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 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 are 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 for developing depression and withdrawing from normal 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 can be prescribed to relax over-toned and contracted muscles, which in turn reduces pain. Anticholinergic drugs are also used to 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.
Baclofen is among the most common medications used in children with cerebral palsy. It is an antispasmodic drug which 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 a 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 that is chosen 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.
After recovery from the procedure and physical therapy, the child should then 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. It can occasionally be a source of additional pain but, over time, therapy can lessen pain. It has the potential to do this by promoting 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 that has any restriction in movement, proper positioning can play a very large role. This is a significant contribution that physical therapy brings to the treatment of pain in children with cerebral palsy. An example of this would be in addressing sleep problems. For reducing pain during sleep and to achieve better quality sleep, learning how to properly position a child in bed can make a big difference. 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, it is crucial that you 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 help her to live a more comfortable and fulfilling life.