Nearly 9 in 10 adults with cerebral palsy have a documented pain diagnosis, with over half experiencing multiple types of pain, according to a recent large cohort study. Patients with mixed pain types were significantly more likely to receive non-surgical opioids and other therapies.
The study examined data from 41,595 Medicare beneficiaries with cerebral palsy (CP) over the course of a year. Researchers found that 86.7% of patients had at least one chronic pain diagnosis, and 45.6% had a mixed pain phenotype—meaning they were diagnosed with more than one type of pain, including nociceptive, neuropathic, and nociplastic pain, noted Mark D. Peterson, PhD, MS from the Department of Physical Medicine and Rehabilitation, University of Michigan Medicine, Ann Arbor.
Prescription patterns reflect the complexity of pain management in this population. Antiepileptics were the most commonly prescribed therapy (58.2%), followed by antidepressants (48.6%), benzodiazepines (42.8%), NSAIDs (42.6%), and nonperioperative opioids (40.6%). About 41% of the cohort received physical or occupational therapy.
Patients with all three types of pain had the highest rates of opioid use—79.8%—compared with 32.2% for those with nociceptive pain only, and 15.8% for those without any pain diagnosis.
Among those prescribed opioids, the median number of prescriptions was two, with a median supply duration of 11.5 days. There was no significant difference in opioid strength (measured in oral morphine equivalents) between those with and without documented pain.
Patients with co-occurring neurodevelopmental disorders (NDDs)—such as epilepsy or intellectual disability—received fewer pain treatments overall. Only 33.4% of this group received opioids, compared with 50.7% of those without NDDs. Similarly, physical or occupational therapy was prescribed less often to patients with NDDs (38.8% vs 45%).
However, patients with NDDs were more likely to receive antiepileptics (66.1% vs 46.6%), benzodiazepines (49.3% vs 33.4%), and antipsychotics (41.1% vs 22.1%). The study suggests that communication difficulties and diagnostic complexity may affect prescribing patterns for these patients.
"This is the first and largest study to examine pain and symptom treatment patterns on the basis of pain phenotypes and co-occurring NDDs among adults with CP," noted Peterson and colleagues.
The high rate of opioid use—particularly in individuals with nociplastic pain—may not align with best practices for managing centrally driven pain, study researchers noted, calling for improved pain phenotyping and better alignment of treatment strategies with specific pain mechanisms in CP.
They reported no competing interests.
Source: Mayo Clinic Proceedings: Innovations, Quality & Outcomes
