title: Pain in children following microsurgical reconstruction for obstetrical brachial plexus palsy.
abstract: OBJECTIVE
  To determine the prevalence and characteristics of pain experienced by children who have had microsurgical reconstruction for obstetrical brachial plexus palsy (OBPP).
  
  
  METHODS
  A prospective case series study was conducted of 65 children aged 6 to 18 years with a diagnosis of OBPP and who had microsurgery at less than 12 months of age with nerve grafting or transfer. A total of 28 patients (43%) had upper OBPP and 37 (57%) had total OBPP. We evaluated pain using the Faces Pain Scale-Revised and the Adolescent Pediatric Pain Tool. Sensory symptoms in the affected limb were also collected. Mean age was 11.0 ± 3.3 years.
  
  
  RESULTS
  We evaluated 65 children. The point prevalence of pain (pain at the time of assessment) was 25%. The reported lifetime prevalence of pain (experienced anytime during life) was 66%. A total of 71% reported that the affected extremity felt different at least once in their lifetime. Average intensity of those with pain (n = 43) was 40 ± 19 mm on a 100-mm visual analog scale. Seventy percent of children reported that symptoms occurred every day or at least once a week. Anatomical distribution of pain was throughout the affected upper extremity irrespective of the severity of injury, with the exception of children with upper plexus injuries who did not report pain in their hand. Words typically used to describe neuropathic or musculoskeletal symptoms were chosen by the children to represent their pain.
  
  
  CONCLUSIONS
  Children with OBPP who had microsurgical reconstruction commonly reported pain. These symptoms were typically frequent but were episodic and low in intensity. The descriptions of the type of pain include terms typical of both neuropathic and musculoskeletal origins.
  
  
  METHODS
  Prognostic IV.
authors.affiliation: Division of Plastic and Reconstructive Surgery and Department of Rehabilitation Services, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. Electronic address: emily.ho@sickkids.ca.
authors.forename: Emily S
authors.initials: ES
authors.lastname: Ho
authors.affiliation: Rehabilitation Sciences Institute, Department of Physical Therapy and Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Christine G
authors.initials: CG
authors.lastname: Curtis
authors.affiliation: Division of Plastic and Reconstructive Surgery and Department of Rehabilitation Services, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Howard M
authors.initials: HM
authors.lastname: Clarke
mesh_terms: D000293:Adolescent; D020516:Brachial Plexus Neuropathies / Q000601:surgery*; D002648:Child; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008866:Microsurgery; D063806:Myalgia / Q000209:etiology*; D016067:Nerve Transfer; D009437:Neuralgia / Q000209:etiology*; D010246:Paralysis, Obstetric / Q000601:surgery*; D010525:Peripheral Nerves / Q000637:transplantation; D015995:Prevalence; D011446:Prospective Studies; D064232:Visual Analog Scale
keywords: Brachial plexus injury; children; outcomes; pain; teenagers