(379) Pain outcomes following intrathecal baclofen pump implant in individuals with cerebral palsy

Cerebral Palsy (CP) is the most common congenital cause of disability in children. Spasticity is reported in approximately 70% of those with CP and, depending on severity, results in chronic pain and interferes with function. Intrathecal baclofen (ITB) is regarded as relatively effective in the reduction of spasticity associated with CP. Although almost all studies to date report changes in tone, the evidence for other outcomes including pain reduction is typically anecdotal/retrospective. We conducted a prospective study assessing pain intensity, duration, frequency and interference pre/post ITB pump implant. Participants were 32 individuals with CP (mean age= 12 years, 8 months). The majority of participants had a CP diagnosis of quadriplegia (72%) or diplegia (22%) and relied on wheeled mobility (91%; GMFCS level IV-V). For all participants, pain (Brief Pain Inventory [BPI]; Dalhousie Pain Interview [DPI]) and spasticity (Multiple Sclerosis Spasticity Scale [MSSS]) assessments were completed by parent report. A repeated measures ANOVA demonstrated a significant overall effect for pain duration F(2,10)= 4.467, p= .041 with a significant decrease in pain duration from pre (M= 60.04 hours, SD= 90.06 hours) to post surgery (M= 0.50 hours, SD= 1.20 hours; F(1, 11)= 7.946, p= .017). There was also a significant overall effect for spasticity F(1, 7) = 10.697, p = .007 with a significant decrease in spasticity from pre (M= 58.64, SD= 12.78) to post surgery (M= 44.87, SD= 12.12; F(1, 8) = 23.035, p = .001). The MSSS spasticity score correlated significantly with pain duration (r=.35, p=.005) and pain intensity (r=.36, p=.003). Although not statistically significant, pain intensity, frequency and pain interference all decreased following ITB pump implant. This initial analysis supports the anecdotal evidence that pain decreases along with decreases in spasticity related to ITB pump implant. The greatest impact appears to be on the duration of pain experience.