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Impact of Pain in Cerebral Palsy Population: Function and Bioinformatics

This study aims to explore the prevalence, demographics, locations, and nature of self-reported pain in individuals with cerebral palsy (CP). The functional abilities potentially related to pain will also be investigated. Retrospective medical data will be analyzed to determine the characteristics of pain in CP and its impact on functional abilities.

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Impact of Pain in Cerebral Palsy Population: Function and Bioinformatics

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  1. Pain in Cerebral palsy population: Impact on function Bioinformatics PVRM 868 Presented By Sakher Obaidat

  2. Outline • Background • Study Objective • Specific Aims • Methods • Outcomes measures • Data analysis • Results • Specific aim conclusion • Discussion • Limitation • Future Studies

  3. Cerebral Palsy • Persistent but not unchanging • Disorder of movement, tone and posture • Due to non-progressive defect/lesion • Of immature brain ( fetal life, infancy, childhood) • Different Types (Spastic, Ataxic, athetoid, mixed,…) • Associated with many cognitive and physical dysfunctions (Cathels B. Reddihough DS).

  4. Classifications& Complications GMFCS I GMFCS II GMFCS III GMFCS IV GMFCS V

  5. Pain as a Secondary Condition • Pain prevalence in CP 64.6 to 78% (Jahnsen et al. 2004) • Pain was related to the GMFCS level (Houlehan, 2009) • Highest Pain prevalence in GMFCS level II for M and level IV for F (Wright et al. 2008) • No significant trend for increasing GMFCS level (Doralp and Bartlett, 2010)

  6. Pain as a Secondary Condition • Significant pain at much earlier ages (childhood and adolescence) (McKearnan et al. 2004) • No strong association with resulting impairments in body structures and functions (Wright et al. 2008) • However, pain in adults CP is under-recognized and under investigated (Laurie et al. 2010)

  7. Pain as a Secondary Condition • Inconsistent findings about pain in CP: • Heterogeneity of CP types • Narrow age range, with more concern about children and adolescents • No comparison between different age groups • Small sample size

  8. Overall objective • Examine the prevalence, demographics differences, locations, and natures of self reported pain in children, young adults and elderly with CP • We also wanted to explore the functional abilities potentially related to pain in people with CP

  9. Specific Aims • Aim 1: Characterize cohort of CP with reported pain • Aim 2: Explore the relationship between pain and functional abilities

  10. Methods • Retrospective de-identified medical data were collected from the Healthcare Enterprise Repository for Ontological Narration (HERON) • I2b2 codes for CP diagnosis • ICD9 343 Infantile cerebral palsy • ICD10 G80 Cerebral palsy

  11. Outcome measures • Flowsheet: • Pain • 0-10 scale score • Location, duration, and description • Sitting & standing balance levels • Gait • distance, pattern, description, and mobility device • To update GMFCS level

  12. Cohort

  13. Study flowchart

  14. Data Analysis • Data was processed by using SQLite software • Remaining 278 patients • SPSS 23 was used for statistical data analysis • Descriptive analysis, T-test, ANOVA, and Spearman correlation

  15. Study timeline

  16. Aim 1: CP with pain characteristics

  17. CP types: GMFCS GMFCS IV n= 2 GMFCS I n= 16 2.22% 21.11% GMFCS III n= 53 GMFCS II n= 19 17.78% 58.89% Valid n=90

  18. Patient Demographics: Age 9-21 years >21-40 >40-65 years >65 years 45.68% 34.89% 11.15% 8.27%

  19. Patient Demographics: Sex Female n= 134 Male n= 144 51.80% 48.20%

  20. Patient Demographics: Vital Status @ n= 10 7.91% 3.60% Dead n= 22 Alive n= 246 88.49%

  21. Pain: severity

  22. Pain: severity

  23. Pain: characteristics Pain assessments were between 2007-2017

  24. Pain : Gender differences

  25. Pain : Age differences

  26. Aim 1: Conclusions • Back or abdomen with aching and constant nature • First reported pain is significantly different from last reported pain • Significant correlation • Females showed higher pain score more than males • Pain scores among age groups • Group of ages between >40-65

  27. Aim 2: Explore the relationship between pain and functional abilities

  28. Pain: impact on gait

  29. Impact on GMFCS & balance • None of pain scores (average, first and last ) showed any significant relationship with balance level (sitting & standing) or with GMFCS levels

  30. Aim 2: Conclusions • Pain scores did not show any significant relationship with levels of GMFCS, sitting and standing balance levels • Pain is negatively correlated to gait distance

  31. Discussion • No significant relationship with most of functional abilities • Only with gait distance • The pain severity is more age group 40-65 years old • pain in CP is not only childhood problem but persisting lifelong problem • pain should be well addressed from an early age

  32. Limitation • All data provided by HERON and we cannot judge on reliability of these data • DX of CP is not clearly documented in HERON, and the CP distribution and GMFCS are missing for most of our patients, • May weaken the external validity of the study and possibility of generalization

  33. Future Studies • Prospective study for Investigating each type of CP separately • Comparing Pain based topographic distribution • Comparing ambulatory vs non-ambulatory • Investigating other contributing factors such as Fatigue

  34. Questions? Thank You

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