Dados do Trabalho

Título

Pharmacological Management of Chronic Pain in Children and Adolescents with Cerebral Palsy and Hip Dislocation

Introdução

Chronic pain is a common and significant issue in individuals with cerebral palsy, more frequent in those with greater neurological impairment, predominantly in the lower limbs, hip, and abdomen. Hip dislocation is one of the main causes of pain in this population, even in those submitted to orthopedic treatment, leading to difficulty in sleeping, eating, positioning, and daily care. The use of chronic pain medications in this context can assist in the management of these patients.

Objetivo

To present the response to drug treatment for chronic hip pain in patients with cerebral palsy.

Métodos

Prospective study with evaluation of chronic hip pain complaints in patients with bilateral cerebral palsy starting from December 2020 at SARAH/Brasília Hospital. A pain scale (Paediatric Pain Profile – PPP) validated in Brazil for this population (Inventory of Pain Behavior in Neurological Disability-– ICDDN) was used and treatment with amitriptyline and/or gabapentin was instituted.

Resultados

We followed 32 patients with bilateral cerebral palsy and chronic hip pain, 28 with hip dislocation, and four with subluxation, mean age of 14 years, 48% female. In the GMFCS (Gross Motor Function Classification System) classification two patients were level IV and 30 level V. Fourteen had undergone hip surgery (tenotomy, reconstruction surgery, or salvage surgery) and 15 had undergone one or more intra-articular injections (infiltration) with depomedrol and anesthetic associated with the anterior branch of the obturator nerve block for pain treatment but maintained this complaint. Amitriptyline was indicated for 22 patients, gabapentin for 19, with nine patients requiring a combination of both medications. All patients took the pain inventory (ICDDN) before and after the introduction of medication. Improvement of pain complaints was observed in 81% of patients. There was a significant reduction in pain scores (p < 0.0001). Persistent or recurrent pain was observed in six patients (19%), four of whom underwent hip infiltration and two reconstruction surgery. The mean follow-up was 12 months.

Conclusões

The use of amitriptyline and/or gabapentin for the treatment of chronic hip pain in individuals with cerebral palsy resulted in better pain control, being a good coadjuvant therapeutic option in the follow-up of these patients.

Palavras chave

#cerebral palsy #pain #hip dislocation

Referências (se houver)

1. Warlow T, Hain R. ‘Total Pain’ in Children with Severe Neurological Impairment. Children 2018, 5, 13
2. Eriksson E., Hagglund G, Alriksson-Schmidt A. Pain in children and adolescents with cerebral palsy – a cross-sectional register study of 3545 individuals. BMC Neurology 2020; 20:15 1-9
3. Hauer, J.; Houtrow, A.J. Pain assessment and treatment in children with significant impairment of the central nervous System. Pediatrics 2017, 139.
4. Larsen S, Ramstad K, Terjesen T. Hip pain in adolescents with cerebral palsy: a population-based longitudinal study. Dev Med Child Neurol 2021, 63: 601–607
5. McKinnon CT, Meehan EM, Harvey AR, Antolovich GC, Morgan PE. Prevalence and characteristics of pain in children and young adults with cerebral palsy: a systematic review. Dev Med Child Neurol 2019; 61: 305–14.
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7. Pasin S. Validação transcultural do instrumento paediatric pain profile para avaliação de dor em crianças com paralisia cerebral grave. Dissertação (mestrado) Universidade Federal do Rio Grande do Sul. Programa de Pós-Graduação em Enfermagem 2011.

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