Tuesday, July 16, 2013

Study flags pain in kids with cerebral palsy

One in four children with cerebral palsy has moderate to severe pain that limits activities, according to a study published yesterday in Pediatrics.

Caregivers filled out a survey and doctors reported the presence and cause of pain in 252 youth aged three to 19 in this Holland Bloorview study.

Hip pain and tight muscles were the most frequent causes of pain “and have specific treatments,” says lead researcher Dr. Darcy Fehlings, physician director of the Child Development Program at Holland Bloorview and clinician senior scientist at the Bloorview Research Institute.

For example, regular hip x-rays can identify partial hip dislocation (called hip subluxation), which can be treated with stretching, hip abduction bracing, Botox and orthopedic surgery, before complete dislocation and chronic pain develop.

“A number of treatments exist for dystonia, ranging from oral medication, [Botox], intrathecal baclofen pumps, and, more recently, deep brain stimulation, to help prevent children from becoming ‘stuck’ in painful postures,” the researchers say.

The main cause of pain in 10 per cent of the children and youth was constipation, which can be effectively treated with the laxative polyethylene glycol.

"This study underlines the importance of asking every child with cerebral palsy about their pain levels," says Dr. Melanie Peller, a fellow in developmental pediatrics at Holland Bloorview. "This can sometimes pose a challenge for children with communication limitations, which makes a systematic pain assessment plan crucial."


Hi Louise,

Although I haven't blogged or written in awhile, I still miss you terribly, and remain a staunch supporter of family advocacy, narrative medicine and the use of social media within the healthcare system.

Thus, and with this in mind, I would like to humbly ask you for your assistance, as I have a question for Dr. Fehlings:

"Could undergoing a tibial osteotomy reverse or rectify hip subluxation for those with spastic paraplegia cerebral palsy (those who walk with walkers or forearm crutches)?"

I thank you with all I have to give.

Yours truly,

Matt Kamaratakis

Hi Matt -- Thanks for your message. Here is Dr. Fehling's reply:

Thank-you so much for your interest in our work here at Holland Bloorview. Unfortunately we can’t answer individual reader’s health care questions. We would encourage you to link with your family doctor who can help to connect you with an adult specialist (for example, at the cerebral palsy clinics at Toronto Rehabilitation Hospital or WestPark).