The impact of pain in children and adolescents with cerebral palsy: A daily diary study

BACKGROUND: Pain is the most prevalent secondary condition in youth with Cerebral palsy (CP); yet existing research has consistently overlooked the dynamic nature of pain and its impact on functioning in youth with CP. Using a daily diary methodology, this study investigated the association between pain intensity and interference, as well as how mental health symptoms and quality of life (QoL) impact daily fluctuations, or the magnitude of daily changes in pain intensity and interference, in youth with CP. METHOD: Forty-five youth with CP, along with their caregiver, completed baseline measures of pain, depression, anxiety, and QoL. Youth completed daily measures of pain intensity and interference for seven days. Multi-level modelling investigated the bi-directional associations between pain intensity and same-day and next-day functioning interference. Hierarchical linear regressions examined if baseline mental health and QoL were associated with fluctuations in pain over the seven days. RESULTS: Forty percent (n = 18) of participants had chronic pain. Daily pain intensity was significantly associated with same-day and next-day pain interference. Lower baseline QoL was associated with greater fluctuations in both pain intensity and interference, above the effects of gross motor abilities and age. While higher baseline depressive symptoms were only associated with pain intensity, anxiety symptoms were not associated with any pain outcomes. CONCLUSIONS: As the first study to investigate the variable nature of pain in youth with CP, the findings provide critical information for targeted pain management interventions that can offset worsening mental health issues, reduced QoL, and impaired daily functioning.