Pain Prevalence in Brachial Plexus Birth Injury
Kristen M Davidge, MD, MSc, FRCS(C); Emily S. Ho, BSc OT Reg (Ont), MEd; Jenna Belitzky, BSc; Karen Klar, BScPT; Lisa A Isaac, MD, FRCPC; Jennifer Stinson, PhD; Howard M. Clarke, MD, PhD, FRCS(C)
The Hospital for Sick Children, Toronto, ON, Canada
Introduction Chronic pain following brachial plexus birth injury (BPBI) remains poorly understood. The onset of pain following BPBI is atypical for a nerve injury in that it is delayed, typically occurring in late childhood or adolescence; as such, it has been vastly under-recognized. Pain prevalence estimates have ranged from 25% to 92% in prior studies. Early data suggest that upper limb pain in BPBI is typically frequent, episodic, and of low-to-moderate intensity but 8% of children have severe, chronic pain. However, existing data are limited. The goal of this study was to establish the prevalence of pain in children and adolescents with BPBI.
Materials & Methods: A cross-sectional survey of children with BPBI was conducted to determine the point prevalence of pain in children 8 to 18 years. Children aged 7 years or less were excluded because 8 years is the minimum age of self-report for multidimensional pain measures. Eligible patients were identified from our prospective research database (1993-present; 98.5% population inclusion). We excluded patients with cognitive or developmental delay, and recent upper limb injury (<3 months). The self-report survey included the Faces Pain Scale-Revised (FPS-R) and two questions regarding presence/absence of altered sensation and prior discomfort in either upper limb. Point prevalence of pain was determined by the proportion of patients with an FPS-R score greater than 0. Survey implementation followed the modified Dillman Tailor Design Method.
Results: 760 children with BPBI were identified as eligible for study inclusion. Preliminary data from 114 respondents (59% female; mean age 14.7 ± 3.2 years) demonstrates a point prevalence of pain of 44% (n=50) in the affected upper limb. Among those reporting pain on the FPS-R, the scores ranged from 2-10: score 2 (n=24), 4 (n=14), 6 (n=10), 8 (n=1), 10 (n=1). Eighty-three children (73%) reported altered sensations in their affected upper limb, and utilized a variety of musculoskeletal and neuropathic pain descriptors to qualify these sensations. Sixty-two children (55%) reported prior pain in their affected upper limb. In the unaffected upper limb, current pain was reported by 9% (n=10) and prior pain by 17% (n=19) of children with BPBI.
Conclusion: This study provides evidence that pain is common in older children and adolescents with BPBI, with a preliminary prevalence estimate of 44%. Children reporting pain on this survey are currently undergoing a more in-depth assessment of pain characteristics and pain interference to further clarify the pain experience in BPBI.
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