Parent-proxy ratings of pain before and after botulinum toxin type A treatment for children with spasticity and cerebral palsy

OBJECTIVE: To test the hypothesis that pain would be reduced after botulinum toxin type A (Btx/A) treatment for children with cerebral palsy (CP). METHOD: Thirty-four pediatric patients with CP (mean age 9 ‰y; 56% male) and their parents were recruited through a regional specialty healthcare center medical clinic and pain research program. A 1-group pretest, posttest treatment design was used on the basis of a standardized parent-proxy report of their child's pain. RESULTS: Overall parent ratings of their child's pain were significantly reduced after Btx/A injection with 62% of parents reporting the absence of pain 1 month after injection (proportion≤0.38; 95% confidence interval≤0.23-0.55). There were no significant differences for males or females. CONCLUSIONS: Although there is considerable evidence that Btx/A is efficacious for the treatment of spasticity associated with CP, there is little direct evidence specific to associated analgesic effects after Btx/A treatment. These preliminary findings indicate that Btx/A treatment for spasticity resulted in significant pain reduction for this patient sample. This was the first study to directly ask parents about their child's pain pre-Btx/A and post-Btx/A treatment. These findings have implications for the management of pain associated with spasticity and CP and suggest further research is warranted.