title: Parent-proxy ratings of pain before and after botulinum toxin type A treatment for children with spasticity and cerebral palsy.
abstract: OBJECTIVE
  To test the hypothesis that pain would be reduced after botulinum toxin type A (Btx/A) treatment for children with cerebral palsy (CP).
  
  
  METHODS
  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.
authors.affiliation: Gillette Children's Specialty Healthcare, Neurodevelopment Pediatrics, University of Minnesota, Minneapolis, MN, USA. symon007@umn.edu
authors.forename: Patrick F
authors.initials: PF
authors.lastname: Rivard
authors.forename: Andrea C
authors.initials: AC
authors.lastname: Nugent
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Symons
mesh_terms: D000293:Adolescent; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D002547:Cerebral Palsy / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D009128:Muscle Spasticity / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D009465:Neuromuscular Agents / Q000627:therapeutic use; D010146:Pain / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy*; D010147:Pain Measurement / Q000187:drug effects; D010290:Parents; D019727:Proxy; D016896:Treatment Outcome
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A