Pain characteristics and interference in children with brachial plexus birth injury
Kristen M Davidge, MD, MSc, FRCS(C)1, Jenna Belitzky, BSc2, Jennifer Stinson, PhD2, Emily S. Ho, BSc OT Reg (Ont), MEd1 and Howard M. Clarke, MD, PhD, FRCS(C)3, (1)The Hospital for Sick Children, Toronto, ON, Canada, (2)Sick Kids Hospital, Toronto, ON, Canada, (3)Division of Plastic and Reconstructive Surgery, Hospital for Sick Children, Toronto, ON, Canada
Introduction: In a recent cross-sectional study of 202 children aged 8-19 years, we demonstrated that point prevalence of pain in brachial plexus birth injury (BPBI) was 42% and that a key predictor of this pain was cervical root avulsion. The purpose of this study was to evaluate self-report pain characteristics and pain interference in children with BPBI.
Materials & Methods. All children 8-19 years reporting pain in the initial survey were invited to participate in a subsequent cross-sectional, descriptive study of pain characteristics (intensity, distribution, quality, frequency, onset) and pain interference in BPBI. Pain assessments were completed in-person or through video teleconference, using two validated self-report pediatric measures, the Adolescent Pediatric Pain Tool (APPT) and the pain interference scale of the Pediatric Pain Questionnaire (PI-PPQ).
Results. 83 of 123 eligible children (mean age 14.6 ± 3.2 years, 63% female) have completed the pain assessments thus far. Mean age of pain onset was 8.1 ± 1.7 years, with 2 patients reporting complete resolution of their symptoms within 1 year. Most commonly, participants reported occasional pain (range, “never” to “often”) with a mean pain intensity of 42.0 ± 22.3 mm (range, 0 to 80.5 mm) on the APPT 100mm visual analogue scale. Children with total plexus palsies had more severe pain than children with upper plexus palsies (64.3 ± 20.1 vs 34.5 ± 17.5, P <0.0001). The shoulder was the most frequently circled pain location, endorsed by 70% of children, followed by the elbow by 27%, and the hand by 25%. Hand pain was reported by children with both upper and total plexus palsies. The median total number of pain descriptors circled on the APPT was 17 (range 0-36 out of 67 possible words), with 92% of children selecting a mixture of neuropathic and nociceptive descriptors. The median ratio of neuropathic to nociceptive words selected was 0.63 (range, 0 to 8). Sixty-nine children (83%) reported that their pain sometimes, often or always impacted at least one of 11 different activities on the PI-PPQ; “sports”, “sleeping” and “seeing friends” were the most commonly affected activities.
Conclusions. Pain in BPBI is typically spontaneous and intermittent, ranging in intensity from mild to severe. The etiology of this pain remains unclear, with pain location and descriptor data suggesting both musculoskeletal and neuropathic origins as plausible. Importantly, pain in BPBI negatively impacts the child's function.
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