Russo Remo N, Miller Michelle D, Haan Eric, Cameron Ian D, Crotty Maria
Flinders University Rehabilitation Studies Unit, South Australia.
Clin J Pain. 2008 May;24(4):335-42. doi: 10.1097/AJP.0b013e318162eae0.
To describe and characterize the prevalence and quality of pain in a population-based community sample of children with hemiplegic cerebral palsy.
Outcomes were assessed from 2 domains of the World Health Organization International Classification of Functioning, Disability and Health: body structure/function (upper limb spans, modified Ashworth scale, Tardieu scale, sensory function), activities-participation (Assessment of Motor and Process Skills), Pediatric Quality of Life Inventory (PedsQL), and self-perception (Harter Self-Perception Profile).
There were 107 participants of age (mean, 95% confidence interval) 8.94 years (8.23 to 9.65); 61 (57%) were boys and 58 (54%) had hemiplegia affecting the right side. Fifty-one (48%) reported pain. Pain mostly affected the involved side (n=28, 55%) and lower limb (n=19, 37%). Eighteen (35%) reported moderate to severe pain. Thirty-five (69%) said pain impacted on movement/activity and was of an aching quality (n=29, 57%). Mean (95% confidence interval) quality of life according to Pediatric Quality of Life Inventory was significantly lower for children experiencing pain compared with children experiencing no pain [parent 50.2 (45.9 to 54.5) vs. 60.1 (55.1 to 65.1), P<0.01; child 60.5 (55.4 to 65.6) vs. 75.8 (68.4 to 83.2), P<0.01]. The self-perception domains of Scholastic Competence [no pain, 3.02 (2.78 to 3.26); pain, 2.55 (2.31 to 2.79) P<0.01] and Behavioral Competence [no pain, 3.33 (3.07 to 3.60); pain, 2.88 (2.70 to 3.06) P<0.01] were significantly lower in children with pain aged > or =8 years.
Pain is common in children with hemiplegic cerebral palsy with qualities suggesting a nociceptive origin. Pain is associated with lower quality of life and self-perception. Results suggest clinicians should assess and actively manage pain in this population.
描述并刻画以社区为基础的偏瘫型脑瘫儿童样本中疼痛的患病率及质量。
从世界卫生组织《国际功能、残疾和健康分类》的两个领域评估结果：身体结构/功能（上肢跨度、改良Ashworth量表、Tardieu量表、感觉功能）、活动-参与（运动和过程技能评估）、儿童生活质量量表（PedsQL）以及自我认知（哈特自我认知量表）。
共有107名参与者，年龄（均值，95%置信区间）为8.94岁（8.23至9.65岁）；61名（57%）为男孩，58名（54%）偏瘫影响右侧。51名（48%）报告有疼痛。疼痛主要影响受累侧（n = 28，55%）和下肢（n = 19，37%）。18名（35%）报告有中度至重度疼痛。35名（69%）表示疼痛影响运动/活动，且性质为酸痛（n = 29，57%）。与无疼痛的儿童相比，有疼痛的儿童根据儿童生活质量量表得出的平均（95%置信区间）生活质量显著更低[家长评分：50.2（45.9至54.5）对60.1（55.1至65.1），P<0.01；儿童评分：60.5（55.4至65.6）对75.8（68.4至83.2），P<0.01]。在8岁及以上有疼痛的儿童中，学业能力[无疼痛，3.02（2.78至3.26）；有疼痛，2.55（2.31至2.79），P<0.01]和行为能力[无疼痛，3.33（3.07至3.60）；有疼痛，2.88（2.70至3.06），P<0.01]的自我认知领域显著更低。
疼痛在偏瘫型脑瘫儿童中很常见，其性质提示为伤害性起源。疼痛与较低的生活质量和自我认知相关。结果表明临床医生应对该人群的疼痛进行评估并积极管理。
