Medications for cerebral palsy in adults may not meet actual needs

Pain and symptom management are important parts of caring for adults with cerebral palsy.

However, these patients are often treated with medications that may not be suitable for the underlying type of symptoms they are experiencing.

This mismatch can lead to adults with cerebral palsy being prescribed medications that are not appropriate for treating the source of their problems, leading patients to take unnecessary medications that can worsen their health or cause additional complications later in life.

By studying the most common pain and symptom management strategies among adults with cerebral palsy, University of Michigan Professor of Physical Therapy and Rehabilitation Mark Peterson, PhD, MS, FACSM, was able to find out if there are differences based on the phenotype of pain or related neurodevelopmental disorders and the medications that are prescribed to treat them.

The study is published in the journal Mayo Clinic Proceedings: Innovations, Quality & Outcomes.

By examining data on prescribing medications and therapies for pain and symptoms of cerebral palsy, Peterson and colleagues identified the most commonly prescribed pharmaceuticals for pain and symptom relief.

These include (from most commonly prescribed to least prescribed): antiepileptics, antidepressants, benzodiazepines, nonsteroidal anti-inflammatory drugs, opioid analgesics, antipsychotics, myorelaxants, irritable bowel syndrome-specific drugs, clonidine, anticholinergics, and botulinum toxin A injections.

Physical and occupational therapy, the two main treatments for pain and symptoms in children with CP, were prescribed to only 41% of adult participants in this cohort.

Unfortunately, not much is still known about common national prescribing patterns for the treatment of pain and related symptoms in cerebral palsy, which could lead to adverse reactions.

“One of the most disturbing findings of this study was that people with a mixed pain phenotype had significantly higher prescribing patterns, ranging from 60% for muscle relaxants to 80% for opioid analgesics,” says Peterson.

Peterson emphasizes that it is important to use appropriate screening tools to better understand not only the type and/or origin of pain, but also its prevalence.

It is critical to understand the potential link between opioid exposure and common symptoms or comorbidities of cerebral palsy, particularly respiratory disorders, psychiatric disorders, bowel disorders, and fall-related fractures.

Continuing to explore ways to properly manage and treat pain and other symptoms in people with cerebral palsy, Peterson and his team created a review with recommendations for treating pain in adults with cerebral palsy. The review, published in the journal Developmental Medicine & Child Neurology, is timed to coincide with a large international project to create the first clinical practice guideline for adults with cerebral palsy.