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Management of pain in children and adolescents with cerebral palsy: a systematic review
Author(s) -
Ostojic Katarina,
Paget Simon P,
Morrow Angela M
Publication year - 2019
Publication title -
developmental medicine and child neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.658
H-Index - 143
eISSN - 1469-8749
pISSN - 0012-1622
DOI - 10.1111/dmcn.14088
Subject(s) - cerebral palsy , medicine , physical therapy , psychological intervention , hypertonia , spasticity , spastic , physical medicine and rehabilitation , anesthesia , psychiatry
Aim To determine the efficacy of interventions for the management of pain in children and adolescents with cerebral palsy ( CP ). Method Electronic databases were searched from the earliest date possible to April 2018 using a mixture of subject headings and free text. Inclusion criteria comprised of studies with (1) diagnosis of CP , (2) under the age of 18 years, (3) intervention for the management of pain, (4) outcome measure of pain, and (5) studies published in English‐language peer‐reviewed journals. Results Fifty‐seven studies met the eligibility criteria. Pain related to ( n =number of studies): hypertonia ( n =17), spastic hip disease ( n =13), procedures for the management of CP ( n =7), postoperative ( n =18), and other ( n =2). Most of the studies were of level III to level V evidence. Interpretation There is level II evidence to support intrathecal baclofen therapy for pain secondary to hypertonia in spastic and spastic‐dyskinetic CP , and non‐pharmacological interventions for procedural pain and pharmacological interventions for postoperative pain. Most studies were restricted by retrospective design and limited use of validated outcome measures. Future research is needed to explore multidisciplinary interventions for chronic pain and pain secondary to dystonia. Clinicians and researchers would benefit from a standardized approach to pain assessment. What this paper adds The strongest evidence exists for pharmacological treatments for postoperative pain in children and adolescents with cerebral palsy (CP). There is moderate evidence for the efficacy of intrathecal baclofen for pain related to hypertonia in predominately spastic CP. There is a lack of standardization in the assessment of pain. There is limited evidence for multimodal and non‐pharmacological strategies in paediatric CP.