Reuters Health: Children with CP may have worse pain, be less active when parents catastrophize

By Lorraine L. Janeczko

If their parents catastrophize pain, children with cerebral palsy (CP) have worse pain and more impaired activities of daily living after intrathecal baclofen (ITB) surgery to control spasticity, according to results of a study presented last month at the International Association for the Study of Pain (IASP) World Congress on Pain in Boston.

"Measuring pain in young people with communication impairments is inherently influenced by the reporter (often parents). This study suggests that parents' own fears about the pain itself may affect their ratings of pain and interference in their child," Dr. Dustin Wallace, director of behavioral health for the Rehabilitation for Amplified Pain Syndromes program at Children's Mercy Kansas City in Missouri, told Reuters Health by email.

"These findings are particularly relevant to clinicians who rely on another's report for any clinical decision making," added Dr. Wallace, who was not involved in the study. "Clinicians should keep in mind that all reporting is affected by myriad factors, both when change is observed and when change is not observed."

Parents completed the Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD) questionnaire, the Parenting Stress Index (PSI), and a modified Brief Pain Inventory (BPI; pain interference) before and after the implant. They completed the Pain Catastrophizing Scale for Parents (PCP-P) at the first research visit.

Dr. Daniel L. Millspaugh, an anesthesiologist and the director of the Comprehensive Pain Management Program of Children's Mercy Kansas City, said by email, "The finding reinforces the critical influence of psychological and social factors in all pain experiences and the unique importance of both child and parent factors in pain and functional assessment in pediatric settings."

"A growing medical literature increasingly shows a convincing correlation between patient and/or child anxiety, catastrophizing, and pre-operative pain, and worse post-operative pain outcomes (short- and long-term)," added Dr. Millspaugh, who also was not involved in the study. "

"I agree with the researchers that this is a unique and potentially vulnerable population wherein pain and functional assessment is inherently complex," he said. "Therefore, gaining a greater understanding of influencing factors will help clinicians interpret and act on behalf of the patient and family."

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Learn more about the Pain Management Program at Children's Mercy