Pain in cerebral palsy makes motor skill activities even more challenging for kids

The presence of pain in children with cerebral palsy can make motor skill activities even more difficult, according to a research letter published in JAMA Network Open.

“Many children with CP experience the secondary condition of pain, which is problematic because children with CP face barriers to participation in motor skill activities,” Haresh D. Rochani, DrPH, assistant professor of biostatistics, epidemiology and environmental health sciences at Georgia Southern University, and colleagues wrote. “Motor performance in activities of daily living among children with CP is markedly lower than that among their age-matched peers. Because of the potential effect of pain on children with CP, we sought to examine the association between pain and activities requiring motor skill performance (ie, difficulty dressing or bathing and participation in sport) among a nationally representative sample of U.S. children with CP.”

Rochani and colleagues analyzed data from the 2017 to 2018 National Survey of Children’s Health. Specifically, they evaluated responses from 151 patients aged 6 to 17 years with a diagnosis of CP and 9,177 typically developing children (TDC).

Study data showed that children with CP, compared with TDC, were much more likely to experience difficulty dressing or bathing (56.9% vs. 0.2%). Further, less than one-half of the children with CP were likely to participate in a sports activity (30.1% vs. 66.3%).

“Chronic pain was also 4.5 times more prevalent in children with CP [33.1% vs. 7.3%],” the researchers wrote. “In addition, there was a significant difference in household incomes between those with CP and TDC, with 43.8% of TDC (4,017 children) living in households with income greater than or equal to 400% of the federal poverty level, compared with only 27.1% of children with CP (41 children).”

Investigators noted that children with CP and pain were 3.03 times more likely to have dressing or bathing difficulty compared with children with CP without pain, after controlling for age, sex and race (adjusted OR = 3.03; 95% CI, 1.42-6.42). Additionally, children with CP with pain, compared with those without pain, were 60% less likely to participate in sports (aOR = 0.4; 95% CI, 0.35-0.45).

“As expected, difficulty dressing or bathing and low participation in sport were much more common among children with CP than among TDC,” Rochani and colleagues wrote. “A novel finding of this study was that the issue was exacerbated by the presence of pain, which was present in approximately one-third of the children with CP. However, pain also limited participation in sport and was negatively associated with difficulty dressing or bathing among TDC. Although CP is a complicated disorder and the difficulties associated with dressing or bathing and participation in sport are associated with the poor motor control of children with CP, these findings suggest that pain is also a notable contributing factor.”

The researchers suggested that identifying and treating pain in children with CP could improve their participation in motor skill activities.

“Clinicians should consider regularly enhanced approaches to identifying and screening for pain,” they said.