Pain control in children with cerebral palsy: Treat the cause, not the symptoms

Researchers at Holland Bloorview Kids Rehabilitation Hospital have found that more than 25 percent of children with cerebral palsy seen by physicians have moderate to severe chronic pain, limiting their activity. Findings indicate that pediatricians should be aware of chronic pain in this group and try to identify and treat its underlying causes.

The study, led by Dr. Darcy Fehlings, Physician Director of the Child Development Program at Holland Bloorview and Clinician Senior Scientist at the Bloorview Research Institute, was published today in top health journal Pediatrics.

"This study clearly illustrates the extent to which children with cerebral palsy, or CP experience chronic pain," says Fehlings, also an associate professor at the University of Toronto. The study systematically tracked the "Physician diagnosed" cause of pain, finding that hip pain and increased muscle tone were the most common cause of pain for children and youth. "With this knowledge, pediatricians need to be focused on accurately assessing and managing the root cause of this pain."

CP is the most common neurodevelopmental physical disability, occurring in 2 – 2.5 out of every 1000 live births in developed countries. Dr. Fehlings, who leads the Cerebral Palsy Discovery Lab at the Bloorview Research Institute, aimed to better understand the prevalence and impact of pain on children and youth with CP.

Cameron Purdy is a 13 year old boy with cerebral palsy. He and his mom Corinna have been long-time Holland Bloorview clients working with Dr. Fehlings; Corinna even lived at Holland Bloorview for three months in 2009 while Cameron recovered from a surgery.

Corinna Purdy is glad to see Dr. Fehlings' study about chronic pain in kids with CP being published. "It can be hard for kids to explain where the pain is, especially if they've lived with pain their whole life. Maybe they think it's normal, or maybe they are too shy to tell you – either way, you may not know they're in pain. Dr. Fehlings used cartoon faces instead of a 1-10 pain scale, which helped Cameron effectively communicate his pain levels."

Dr. Melanie Penner, a Fellow in Developmental Pediatrics at Holland Bloorview working with Dr. Fehlings, says Cameron and Corinna's experience is typical. "This study has underlined the importance of asking every child with CP about their pain levels. This can sometimes pose a challenge for children with communication limitations, which makes a systematic pain assessment plan crucial."

Developing a strategy to prevent, assess, and manage chronic pain for kids with CP is key to improving their health and quality of life.