Chronic pain is common among patients with cerebral palsy and leads to a significantly negative impact on patients’ quality of life. More studies are needed to better understand the cause of this pain and to develop effective treatments, researchers said in a recent study.
The review study, “Pathophysiology of chronic pain in cerebral palsy: implications for pharmacological treatment and research,” was published in Developmental Medicine & Child Neurology.
Patients with cerebral palsy are often burdened by chronic pain throughout their lives. Several studies have reported that chronic pain affects up to two-thirds of adults and children with cerebral palsy. Not only does chronic pain reduce quality of life, it also has detrimental effects on the social and educational activities of children.
Despite the evidence, pain is the most understudied physical factor of this disease.
Researchers reviewed several aspects of chronic pain in cerebral palsy to one day develop alternative and effective treatment approaches. Chronic pain in cerebral palsy has many causes, and symptoms often appear in the feet, ankles, knees, hips, and lower back.
While the majority of studies link chronic pain to certain cell receptors that respond to tissue damage, called nociceptors, alternative causes include constipation, headaches, gingival disease, and nutritional factors.
Evaluating pain in cerebral palsy patients is challenging, particularly if a mental impairment exists.
Certain biomarkers can help assess the type and level of pain. For example, it has been suggested that the levels of hair cortisol — known as the stress hormone — are elevated in cerebral palsy patients and can be used as a potential biomarker for chronic pain.
Also, functional magnetic resonance imaging — a medical imaging technique used in radiology that can form pictures of organs and the physiological processes of the body — has been found increasingly useful in pain research.
“These tools should be considered for future investigation,” researchers wrote.
Several non-pharmacological strategies, such as massage and counseling, are considered helpful. However, these strategies are currently applied to only a small percentage of individuals.
A better knowledge of the causes of chronic pain in cerebral palsy patients can lead to specialized treatment with a higher probability of reducing pain.
According to the authors, it is important to keep in mind that pain conditions in these patients have different mechanisms and will not respond to the same treatments.
Several new analgesics under development show promise, including inhibitors of ion channels and cannabinoid receptors, nerve growth factor, and calcitonin gene-related peptide. However, translating preclinical findings to human pain biology is a challenging process.
“The preponderance of limited research on chronic pain among children and adults with CP has centred on its prevalence, impact on quality of life, and interference with participation in family, work, and community life,” researchers wrote.
“Clinicians are neglecting or not identifying chronic pain in CP in the great majority of clinical encounters for individuals with CP, despite its high prevalence and importance in negatively impacting quality of life and participation,” they added.
The authors concluded that “a systematic and thorough approach to pain assessment and treatment, such as described in the Chronic Pain Assessment Toolbox for Children with Disabilities should be routine practice.”