🩹 Pain Management

How Common Is Pain?

Pain is one of the most common and significant issues affecting people with CP. Studies show that up to 75% of adults and 50–75% of children with CP experience chronic pain. Despite this, pain is frequently under-recognised, especially in people who have difficulty communicating.

Sources of Pain

• Muscle spasticity and spasms — tight muscles that contract involuntarily
• Joint contractures — permanently shortened muscles pulling on joints
• Hip displacement — one of the most painful conditions in CP
• Musculoskeletal overuse — compensatory movement patterns strain joints and muscles
• Gastrointestinal pain — constipation, reflux, and bloating
• Dental pain — sometimes difficult to identify, especially with communication barriers
• Post-surgical pain
• Pressure injuries — from prolonged sitting in wheelchair
• Neuropathic pain — arising from the nervous system itself

Pain Assessment

Recognising pain in people with CP — especially those with communication difficulties — requires:

• Listening to the person and believing their experience
• Observing for behavioural cues: facial expressions, crying, changes in sleep, appetite, or mood
• Using validated pain assessment tools designed for people with communication limitations
• Regular screening by health professionals
• Input from carers and family members who know the person well

Treatment Options

• Physiotherapy — stretching, strengthening, hydrotherapy, and positioning to reduce musculoskeletal pain
• Medications — paracetamol, NSAIDs, neuropathic pain medications, and spasticity-reducing drugs
• Botulinum toxin injections — for localised spasticity causing pain
• Intrathecal baclofen — for severe generalised spasticity
• Surgery — to address structural causes like hip displacement or severe contractures
• Positioning and seating — a well-fitted wheelchair and correct positioning can reduce pain significantly
• Orthotics — properly fitted braces reduce joint stress

Self-Management Strategies

• Keeping a pain diary to identify patterns and triggers
• Regular gentle exercise and stretching
• Heat or cold therapy for muscle tension
• Relaxation and breathing techniques
• Mindfulness and meditation — growing evidence for chronic pain
• Good sleep hygiene
• Psychological support — pain and mental health are closely linked

Pain is not an inevitable part of CP that must be accepted. If you or someone you care for is in pain, speak up. Effective pain management is available and you deserve it.