In their first article,1 the authors reported their results obtained by administering a standardized in-person interview to each of 100 adults with cerebral palsy. Two thirds reported one or more chronic pain problems most often affecting the low back or legs. A quarter of all those surveyed reported that the pain was constant while another fifth reported that their pain occurred daily. On a scale of 0 (no pain) to 10 (severe pain), the average severity of the pain was 4 and the average degree to which activities were restricted was 3. Those with chronic pain reported only moderate life satisfaction and displayed high levels of stress. A third of those with chronic pain were dissatisfied with their pain management. The authors’ conclusions included that “pain problems may be overlooked and under-treated in this population.”

In the second article,2 the authors looked at the effectiveness of pain relief strategies in 50 adults between the ages of 18 and 76 with pain related to their cerebral palsy. They interviewed their subjects at 6-month intervals over a 2-year period. During that time, the subjects noted very little change in the severity of pain even though they used pain relief strategies more often. Some improvement was noted in those using whirlpool, ultrasound, or transcutaneous electrical nerve stimulation. Among the authors’ conclusions were that many promising strategies were seldom employed, that there was little information available as to the relative effectiveness of various strategies, and accessibility of the potentially effective treatments could be improved.

Comment:
The authors of these two studies have many years of experience in dealing with children and adults with cerebral palsy as well as experience in using standardized questionnaires and interviews in evaluating pain problems. As a result, their findings are probably a fair estimate of the extent of pain problems among adults with cerebral palsy and the difficulties patients encounter in seeking relief. Chronic pain is a common problem in adults with disabilities
associated with cerebral palsy. However, there has been no careful evaluation of the several available strategies for the relief of pain. Such studies are clearly needed.

1 Jenson, M.P., Engle, J.M., Hoffman, A.J. and Schwartz, L. Natural history of chronic pain and pain treatment in adults with cerebral palsy. American Journal of Physical Medicine and Rehabilitation. (June 2004) 83 6: 439-445.
2 Engle, J.M., Jenson, M.P., Hoffman, A.J. and Kartin D. Pain in persons with cerebral palsy: Extension and cross validation. Archives of Physical Medicine and Rehabilitation. (June 2004) 84: 1125-1128.