Musculoskeletal Pain Outcomes Pre- and Post Intrathecal Baclofen Pump Implant in Children With Cerebral Palsy: A Prospective Cohort Study

Chantel C Barney; Alyssa M Merbler; Jean Stansbury; Linda E Krach; Michael Partington; Patrick Graupman; Peter D Kim; Debbie Song; Frank J Symons

doi:10.1016/j.arrct.2020.100049

Musculoskeletal Pain Outcomes Pre- and Post Intrathecal Baclofen Pump Implant in Children With Cerebral Palsy: A Prospective Cohort Study

Arch Rehabil Res Clin Transl. 2020 Mar 9;2(2):100049. doi: 10.1016/j.arrct.2020.100049. eCollection 2020 Jun.

Authors

Chantel C Barney^{1

2}, Alyssa M Merbler¹, Jean Stansbury², Linda E Krach², Michael Partington³, Patrick Graupman², Peter D Kim², Debbie Song², Frank J Symons¹

Affiliations

¹ Department of Educational Psychology, University of Minnesota, Minneapolis, Minnesota.
² Gillette Children's Specialty Healthcare, St Paul, Minnesota.
³ Children's Mercy Kansas City, Kansas City, Missouri.

Abstract

Objective: To characterize musculoskeletal pain intensity, duration, frequency, and interference with activities of daily living in children with cerebral palsy (CP) before and after intrathecal baclofen pump placement.

Design: Prospective cohort study.

Setting: Children's tertiary hospital.

Participants: Participants were children with CP (N=32; 53% male; mean age, 9.9y; age range, 4-17y). The majority of participants had a CP diagnosis of quadriplegia (76%) and relied on wheeled mobility (91%).

Interventions: Assessments were completed pre- and post intrathecal baclofen pump implant.

Main outcome measures: Because of considerable patient heterogeneity, both pain measures (Brief Pain Inventory, Dalhousie Pain Interview) were completed by proxy (parent) report at the time of the procedure and approximately 6 months after intrathecal baclofen (ITB) pump placement.

Results: Prior to implant, 31% of participants were living with constant pain, which reduced to 6% post ITB implant (P<.001). Based on Wilcoxon signed rank tests, pain duration significantly decreased post ITB pump implant (P<.01).

Conclusions: This prospective analysis supports the anecdotal and retrospective evidence that musculoskeletal pain decreases in CP following ITB pump implant. The greatest effect appears to be on the duration of pain experience. Pain did not decrease for all individuals, and it would be worth further investigation to better understand the relation between patient characteristics and pain outcomes.

Keywords: BPI, Brief Pain Inventory; CP, cerebral palsy; Cerebral palsy; DPI, Dalhousie Pain Interview; ICF, International Classification of Functioning, Disability and Health; ITB, intrathecal baclofen; MAS, Modified Ashworth Scale; Musculoskeletal pain; Pediatrics; Rehabilitation.