Lisa Letzkus1, Darcy Fehlings2, Lauren Ayala3, Rachel Byrne4, Alison Gehred5, Nathalie L Maitre6,7, Garey Noritz6, Nathan S Rosenberg6, Kelly Tanner8, Jilda Vargus-Adams9, Sarah Winter3, Dennis J Lewandowski7, Iona Novak10. 1. Neurodevelopmental and Behavioral Pediatrics, Department of Pediatrics, 2358University of Virginia School of Medicine, UVA Children's, Charlottesville, VA, USA. 2. Department of Pediatrics, 37205Holland Bloorview Kids Rehabilitation Hospital, University of Toronto, Ontario, Canada. 3. Department of Pediatrics, 12348University of Utah School of Medicine, Salt Lake City, UT, USA. 4. 459814Cerebral Palsy Foundation, New York, NY, USA. 5. 2650Nationwide Children's Hospital, Grant Morrow III Library, Ohio State University, Columbus, OH, USA. 6. Department of Pediatrics, 2650Nationwide Children's Hospital, Columbus, OH, USA. 7. Center for Perinatal Research, 51711Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA. 8. Division of Clinical Therapies, 2650Nationwide Children's Hospital, Columbus, OH, USA. 9. 2518Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA. 10. Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
Abstract
BACKGROUND: Pain is common in children with cerebral palsy. The purpose of this systematic review was to evaluate the evidence regarding assessments and interventions for chronic pain in children aged ≤2 years with or at high risk for cerebral palsy. METHODS: A comprehensive literature search was performed. Included articles were screened using PRISMA guidelines and quality of evidence was reviewed using best-evidence tools by independent reviewers. Using social media channels, an online survey was conducted to elicit parent preferences. RESULTS: Six articles met criteria. Parent perception was an assessment option. Three pharmacologic interventions (gabapentin, medical cannabis, botulinum toxin type A) and 1 nonpharmacologic intervention were identified. Parent survey report parent-comfort and other nonpharmacologic interventions ranked as most preferable. CONCLUSION: A conditional GRADE recommendation was in favor of parent report for pain assessment. Clinical trials are sorely needed because of the lack of evidence for safety and efficacy of pharmacologic interventions.
BACKGROUND: Pain is common in children with cerebral palsy. The purpose of this systematic review was to evaluate the evidence regarding assessments and interventions for chronic pain in children aged ≤2 years with or at high risk for cerebral palsy. METHODS: A comprehensive literature search was performed. Included articles were screened using PRISMA guidelines and quality of evidence was reviewed using best-evidence tools by independent reviewers. Using social media channels, an online survey was conducted to elicit parent preferences. RESULTS: Six articles met criteria. Parent perception was an assessment option. Three pharmacologic interventions (gabapentin, medical cannabis, botulinum toxin type A) and 1 nonpharmacologic intervention were identified. Parent survey report parent-comfort and other nonpharmacologic interventions ranked as most preferable. CONCLUSION: A conditional GRADE recommendation was in favor of parent report for pain assessment. Clinical trials are sorely needed because of the lack of evidence for safety and efficacy of pharmacologic interventions.