Cerebral Palsy and Multidisciplinary Pain Management
Cerebral palsy affects an estimated 800,000 people in the U.S, and 3 out of every 1,000 children. It’s a condition that affects every aspect of the human body, from movement, and muscle tone to developmental brain abnormalities, vision and hearing problems, and seizures. According to the Centers for Disease Control, about 10,000 babies per year in the U.S. will develop cerebral palsy, and of these babies, many of them will need specialized physical therapy and pain management doctors throughout their lives.
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What is Cerebral Palsy?
Cerebral palsy (CP) is defined by the Mayo Clinic as a disorder of movement, muscle tone, or posture that is caused by injury or abnormal development in the immature brain, most often before birth. Cerebral actually refers to the brain while Palsy refers to the physical aspects of the condition. Though most cases of cerebral palsy develop before birth, CP can be the direct result of a traumatic brain injury at any point in life.
Symptoms of CP occur in the first few years of life, or soon after a traumatic accident, and only worsen as time goes on. Although symptoms vary greatly, there is rarely a misdiagnosis issue with it comes to CP. The Cerebral or neurological symptoms can include difficulty with vision or hearing, seizures, abnormal pain perceptions, dental problems, and intellectual disabilities. On the Palsy, or physical, sides of things, symptoms include variations in muscle tone, ‘spastic’ or ‘rigid’ muscles, tremors, motor skill delays, favoring one side of the body, difficulty swallowing, difficulty with sucking or eating, delayed speech, and difficulty with precise motions.
While there are many types of cerebral palsy, the most common is Spastic CP which includes rigid, tight, and spastic muscles, muscles only functioning properly on one side of the body, or severe muscle and movement difficulties so that a wheelchair is required. Other forms of cerebral palsy include Athetoid Dyskinetic, Ataxic, Hypotonic, Congenital, or Erb’s CP.
What Causes Cerebral Palsy?
The exact cause of many cases of cerebral palsy can be hard to pinpoint. If CP occurs in an adult, it’s easier to see that a traumatic event or accident has occurred to damage the brain, but before birth, it’s hard for physicians to determine the exact cause of CP.
Cerebral Palsy is not one disease with a single origin, like chicken pox or measles. It is a group of disorders that are related but probably stem from a number of different causes. When physicians diagnose Cerebral Palsy in an individual child, they look at risk factors, the symptoms, the mother’s and child’s medical history, and the onset of the disorder.
There are, however, common factors that may lead to the type of brain development issues that can cause CP. These predictors include drugs and alcohol, infection such as rubella, toxoplasmosis, syphilis, or chickenpox, exposure to toxins such as methyl mercury, thyroid problems, lack of oxygen or blood supply, or premature birth.
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Pain Management for Cerebral Palsy
Pain management doctors who specialize in pediatrics and special needs have supreme knowledge of the intricacies of cerebral palsy. With this condition comes a different reaction to pain, a different understanding of pain, and pain doctors must be able to communicate to parents and children the aspects of treatment.
Children with CP understand pain differently than children with normal brain function and physical movement. Many times, this condition brings with is an extremely sensitive pain threshold. Pain is experienced in a different ways and on different levels, so a pediatric pain doctor must use specific pain assessment to determine exactly where the child’s pain is coming from.
Children with CP often have prolonged experiences of pain that can keep them in and out of the pain doctor’s office throughout their lives. Nerves and tendons become easily injured to the ‘spastic’ and ‘rigid’ nature of muscles, as well as spasms and seizures that can add extreme pressure to different areas of the body. Joints become easily inflamed and patterns of wear and tear appear quite frequently in areas that are repeatedly spasming.
When muscles are tight for great lengths of time, or when the brain cannot control those muscles, spasticity occurs. Spasticity is an imbalance of signals from the central nervous system to the muscles, according to WebMD, and the most common symptom of cerebral palsy. Because the muscles are hard at work at all times of the day and night, there is a great deal of pain associated with spasticity.
Another form of pain that is quite common to those living with CP is chronic back pain. Because of the many spinal deformities (scoliosis, kyphosis, lordosis) associated with cerebral palsy, upper and lower back pain is seen in many patients. These spinal deformities can make sitting, standing, and walking incredibly uncomfortable and even painful.
Pain doctors most commonly refer to physical therapists, behavioral therapists, prescription medications, and a neurologist when treating patients with cerebral palsy. By using a multidisciplinary team of medical experts, a pain doctor can treat all aspects of the child’s condition.
A physician, such as a pediatrician, pediatric neurologist, or pediatric physiatrist, who is trained to help developmentally disabled children. This doctor, who often acts as the leader of the treatment team, integrates the professional advice of all team members into a comprehensive treatment plan, makes sure the plan is implemented properly and follows the child’s progress over a number of years. – The National Institute of Neurological Disorders and Stroke.
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