Pain in Children with Obstetrical Brachial Plexus Palsy and Primary Microsurgical Reconstruction
Emily S. Ho, BSc, OT, MEd1; Christine G. Curtis, BSc, PT2; Howard M. Clarke, MD, PhD, FRCS(C)1
1Division of Plastic and Reconstructive Surgery, Hospital for Sick Children, Toronto, ON, Canada; 2Department of Rehabilitation Services, Hospital for Sick Children, Toronto, ON, Canada
Introduction: Our understanding of the pain experienced by children with obstetrical brachial plexus palsy (OBPP) is limited. The purpose of this study was to determine the prevalence and characteristics of pain experienced by children with OBPP who have undergone microsurgical reconstruction.
Materials and Methods: A prospective case series of children between 6 to 18 years with a diagnosis of OBPP who had microsurgery at less than 12 months of age with nerve grafting or neurotisation was conducted. Pain was evaluated using the Faces Pain Scale - Revised (FPS-R) and the Adolescent Pediatric Pain Tool (APPT). Sensory symptoms in the affected limb were also collected.
Results: Sixty-five children were evaluated: 28 (43%) upper plexus and 37 (57%) total plexus palsy. The mean age was 11.0 ± 3.3 years. The point prevalence of pain was 24.6%. The reported lifetime prevalence of pain was 66.2%. Seventy-one percent reported that their affected extremity felt different at least once in their lifetime. The 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. The anatomical distribution of the 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. A mix of words typically used to describe neuropathic or musculoskeletal symptoms were chosen by the children to represent their pain. However, the children were more likely to report words associated with neuropathic symptoms when asked about the sensation in their limb as opposed to pain.
Conclusions: Children with OBPP who had microsurgical reconstruction commonly report pain. This pain is typically frequent, but episodic and low in intensity. The descriptions of the type of pain experienced include terms typical of both neuropathic and musculoskeletal origins.
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