Correlation of Spasticity and Pain in Adolescents and Adults with - PDF document

1 Correlation of Spasticity and Pain in Ad
Correlation of Spasticity and Pain in Adolescents and Adults with Cerebral Palsy Megan Flanigan, MD 1,2 ; Deborah Gaebler - Spira , MD 1,2 ; Christina Marciniak , MD 1,2, ; Masha Kocherginsky , PhD 1, 1 Northwestern University Feinberg School of Medicine, Chicago, Il; 2 Shirley Ryan AbilityLab , Chicago, Il Contact Information: Megan Flanigan mflanigan@srala b .org | Deborah Gaebler - Spira dgaebler@sralab.org | Christina Marciniak cmarciniak@sralab.org | Masha Kocherginsky mkocherg@northwestern.edu Results Conclusions Introduction - Informed consent was obtained from participants or their legally authorized representative . - Demographic information was obtained by interview . - Participants self - rated : • S pasticity using the Penn Spasm Frequency scale ( PSFS); • Pain on the Brief Pain Inventory (BPI ) (averaged over past week) • Pain Interference using the PROMIS - For those with cognition precluding above ratings, caregivers rated: • T he Care and Comfort Questionnaire (CCQ) - Two examiners rated hypertonicity at the bilateral knee extensors, wrist flexors and elbow flexors using : • Modified Ashworth Scale (MAS ) • Tardieu Scale , with spasticity angles calculated - The MAS and Spasticity Angle Scores were each summed across sides and sites . - Data Analysis : • The PSFS score, summed MAS, summed Tardieu spasticity angles, BPI average for past week, and PROMIS pain interference T scores were evaluated for associations using Spearman correlation coefficients . • L inear regression models were used to determine correlations between the three spasticity and two pain measures, adjusted for Gross Motor Function Classification System (GMFCS) level and age. • Insufficient numbers of subjects with CCQ ratings precluded evaluations with this measure. - 47 subjects ( 27 female) were recruited with a mean age of 35 . 63 years (range 18 - 71 ) . - GMFCS levels were I - 7 , II - 9 , III - 9 , IV - 15 , V - 7 - 26 subjects reported an average pain greater than zero on the BPI rating of average over the past week ; of those with pain rated � 0 , mean BPI was 4 . 04 - Mean PSFS was 0 . 96 (range 0 - 4 ) - Mean PROMIS pain interference T score was 48 . 52 (range 40 . 7 - 77 ) . - Five subjects did not complete the pain questionnaire, four subjects did not complete the BPI . - Self - rated spasm scores on the PSFS demonstrated better correlation with pain levels and pain interference than physician ratings on the MAS or the Tardieu . - Interestingly pain increased with age but not with increasing GMFCS level . - Variations in cognition of subjects precluded self - ratings for all scales - The average PROMIS pain interference T score is less than the average score for the general population (average of 50 ) which does not coincide with prior knowledge of pain in the cerebral palsy population . - Vogtle LK ( 2009 “Pain in adults with cerebral palsy : impact and solutions” . Developmental Medicine and Child Neurology . 51 4 : 113 - 121 . - Engel JM, Jensen MP, Hoffman AJ, Kartin D . ( 2002 ) . “Pain in persons with cerebral palsy : extension and cross validation . ” Archives of Physical Medicine and Rehabilitation . 84 8 : 1125 - 1128 . - Scwartz L, Engel JM, Jensen MP . ( 1999 ) “Pain in persons with Cerebral palsy” Archives of Physical Medicine and rehabilitation . 80 10 : 1243 - 1246 Participants Procedure Limitations - Individuals with Cerebral Palsy (CP) frequently report significant pain - The etiology of pain in children has been attributed hip dislocation/subluxation, dystonia, spasticity, muscle spasms, contractures and muscle overuse - 23 - 84 % of adults with CP reporting consistent pain, which increases with age . - The etiology for pain in adults with CP is unclear, including whether spasticity contributes to increased pain levels . - Hypothesis for this study was that higher levels of spasticity in adults with CP would be associated with greater pain levels . Materials & Methods References - Data for this study was extracted from information obtained in a prospective study of individuals with CP recruited for a study activity and nutrition . - Inclusion criteria for the study were Individuals with CP and ages 16 - 89 years Pain vs. Spasticity scales and Spearman's correlation Spasticity Pain Slope P value MAS PROMIS T 0.268 0.434 PSFS PROMIS T 3.237 0.013* Tardieu PROMIS T 0.019 0.107 MAS BPI 0.166 0.1 PSFS BPI 1 0.009* Tardieu BPI 0.003 0.328 Age and BPI average correlation - T he PSFS positively correlated with both BPI and PROMIS pain interference T scores : ρ= 0 . 33 (P= 0 . 01 ) and ρ= 0 . 31 (P= 0 . 01 ), respectively - There was no significant correlation between MAS score or the Tardieu and BPI or PROMIS measures, including following adjusting for GMFCS and age - Statistically significant differences in MAS by GMFCS levels (One - way ANOVA (F( 4 , 41 ) = 3 . 22 , p= 0 . 02 ) with a trend of increased MAS with increased GMFCS level, but not with pain measures, Tardieu or PSFS . - Age was related to BPI with an adjusted R 2 of 0 . 26 and a slope of 0 . 10 (P value 0 . 01 ), however not with other measures evaluated . Results