Pain in adults with cerebral palsy: A systematic review.
Jennifer M Ryan, Jessica Burke, Rachel Byrne and 6 others
PMID 39937705WHAT IT FOUND
Between 24% and 89% of adults with cerebral palsy report pain, more than adults without it.
What helps is unclear: botulinum toxin A and pallidal stimulation showed no benefit, and a physical activity programme and somatosensory therapy showed promise in one small study each.
Key findings
01Pain is common in adults with cerebral palsy, and more common than in adults without it. Across 47 studies covering 29 814 adults, prevalence ranged from 24% to 89%, though the certainty of the comparison with adults without cerebral palsy was low.
02The only factor consistently linked to pain was communication: adults with better everyday communication reported more pain (70%, 69%, 50%, 50% and 38% across communication levels I to V), which the authors suggest may mean pain is being missed in adults who cannot report it easily.
03Only five small studies, 143 adults in total, tested any treatment for pain. Botulinum toxin A and bilateral pallidal stimulation showed no effect, while a 6-month physical activity and sports programme and 12 weeks of somatosensory therapy each showed possible benefit in a single low-certainty study.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for SLPs
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What it does not show
Every included study was judged at high or unclear risk of bias; not one was rated low. The studies were too different from one another to combine, so no single pooled prevalence or effect estimate is given. The range of 24% to 89% partly reflects different definitions of pain and different ways of asking, so the true figure for any one clinic population is unknown. Almost all the evidence on what predicts pain comes from cross-sectional studies, which cannot show that a factor causes pain, and only 5 of the 28 studies used any strategy to account for confounding. The five treatment studies together included 143 adults, four of them with fewer than 50 participants, and in all four randomised trials it was unclear whether allocation was concealed. Small trials like these can exaggerate effects, or miss real ones. The somatosensory therapy study did not report how big the difference between groups was, and did not use a clinically relevant outcome measure. Grey literature and conference abstracts were not searched, so relevant unpublished work may be missing. Adults of any subtype, age and impairment level were included, so the study samples are not comparable with each other or necessarily with the adults you see. No study reported whether the pain assessment tools are practical to use in everyday practice.
Declared interests
The review was supported by a grant from the Cerebral Palsy Foundation. The authors stated they had no interests that might be perceived as posing a conflict or bias.
The easy way to misread this
Do not read the treatment results as showing these therapies work. The 15-point improvement from the activity and sports programme comes from one study of 57 people, and the somatosensory therapy result was a change in pressure pain thresholds with no between-group difference reported. In the botulinum toxin trial for cervical dystonia, the dystonia-specific pain subscale differed between groups at 4 and 12 weeks while the numerical rating scale did not, so that too is not evidence the injections relieve pain.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →