Parent-proxy ratings of pain before and after botulinum toxin type A treatment for children with spasticity and cerebral palsy

Clin J Pain. 2009 Jun;25(5):413-7. doi: 10.1097/AJP.0b013e31819a6d07.

Abstract

Objective: To test the hypothesis that pain would be reduced after botulinum toxin type A (Btx/A) treatment for children with cerebral palsy (CP).

Method: Thirty-four pediatric patients with CP (mean age 9 y; 56% male) and their parents were recruited through a regional specialty healthcare center medical clinic and pain research program. A 1-group pretest, posttest treatment design was used on the basis of a standardized parent-proxy report of their child's pain.

Results: Overall parent ratings of their child's pain were significantly reduced after Btx/A injection with 62% of parents reporting the absence of pain 1 month after injection (proportion=0.38; 95% confidence interval=0.23-0.55). There were no significant differences for males or females.

Conclusions: Although there is considerable evidence that Btx/A is efficacious for the treatment of spasticity associated with CP, there is little direct evidence specific to associated analgesic effects after Btx/A treatment. These preliminary findings indicate that Btx/A treatment for spasticity resulted in significant pain reduction for this patient sample. This was the first study to directly ask parents about their child's pain pre-Btx/A and post-Btx/A treatment. These findings have implications for the management of pain associated with spasticity and CP and suggest further research is warranted.

Publication types

  • Clinical Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Botulinum Toxins, Type A / therapeutic use*
  • Cerebral Palsy / complications
  • Cerebral Palsy / diagnosis
  • Cerebral Palsy / drug therapy*
  • Child
  • Female
  • Humans
  • Male
  • Muscle Spasticity / complications
  • Muscle Spasticity / diagnosis
  • Muscle Spasticity / drug therapy*
  • Neuromuscular Agents / therapeutic use
  • Pain / complications
  • Pain / diagnosis*
  • Pain / drug therapy*
  • Pain Measurement / drug effects
  • Parents*
  • Proxy
  • Treatment Outcome

Substances

  • Neuromuscular Agents
  • Botulinum Toxins, Type A