Clinician Perspectives of Chronic Pain Management in Children and Adolescents with Cerebral Palsy and Dyskinesia

Abstract

Aims

To explore perspectives of clinicians from interdisciplinary teams on the barriers and facilitators to chronic pain management for children and adolescents with cerebral palsy and dyskinesia.

Methods

Interdisciplinary focus groups (n = 2) were conducted at two Australian tertiary pediatric hospitals. Twenty-five experienced clinicians took part, including ten physiotherapists, six pediatricians, four rehabilitation physicians, four occupational therapists, and one speech and language therapist. An external moderator conducted the focus groups and data were analyzed using inductive thematic analysis.

Results

Four key themes emerged: “balancing the intersection of pain and dyskinesia,” “difficulty communicating between so many providers,” “uncertainty surrounding chronic pain education,” and “differing priorities.” Key barriers were identified including a lack of access to some interdisciplinary team members and formalized guidance for health professionals regarding chronic pain education.

Conclusion

Key issues were reported to impact the delivery of coordinated inter-disciplinary chronic pain management at the tertiary level for children and adolescents with cerebral palsy and dyskinesia. In the absence of strong evidence, a strategy for implementing effective chronic pain management for children and adolescents with cerebral palsy and dyskinesia and gaining clinician consensus regarding the best practice management are recommended.

Keywords:

• Cerebral palsy
• children
• dyskinesia
• pain
• qualitative studies

Acknowledgements

The authors would like to thank Adrienne Wiebusch (consumer advisor), Ms. Mahek Dudhwala (Victorian Paediatric Rehabilitation Service, Monash Children’s Hospital), Dr. Kate Willoughby (The Royal Children’s Hospital), Associate Professor Adam Scheinberg (Victorian Paediatric Rehabilitation Service, The Royal Children’s Hospital) for their contributions and in-kind support of this study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This research was completed as part of CM’s PhD, whereby she received living stipends via an Australian Government Research Training Program Scholarship and Centre for Research Excellence in Cerebral Palsy, Murdoch Children's Research Institute, Top-Up Scholarship. CM also received a Career Development Grant from The Research Foundation, Cerebral Palsy Alliance 2017. AH receives a National Health and Medical Research Council Translating Research into Practice Fellowship 2018. This project was supported by Murdoch Children’s Research Institute and the Victorian Governments Operational Infrastructure Support Program.

Notes on contributors

Clare McKinnon

Dr Clare McKinnon, PhD, is a Physiotherapist and Honorary Fellow with the Neurodisability and Rehabilitation Group at the Murdoch Children's Research Institute, Victoria, Australia.

Jennifer White

Dr Jennifer White, PhD, is an Occupational Therapist and Senior Research Fellow at the Research Centre for Generational Health, University of Newcastle, New South Wales, Australia.

Prue Morgan

Professor Prue Morgan, PhD, is the Head of Physiotherapy, Department of Physiotherapy, Monash University, Victoria, Australia.

Adrienne Harvey

Associate Professor Adrienne Harvey, PhD, is a Physiotherapist and Senior Research Fellow with the Neurodisability and Rehabilitation Group, Victoria, Australia.

Catherine Clancy

Ms. Catherine Clancy is a Physiotherapist with the Victorian Paediatric Rehabilitation Service, Monash Children's Hospital, Clayton, Victoria, Australia. She also works in private practice at Centre of Health, Ivanhoe, Victoria, Australia.

Michael Fahey

Associate Professor Michael Fahey, MBBS, PhD, is the Head of Pediatric Neurology at Monash Children's Hospital, Victoria, Australia.

Giuliana Antolovich

Dr Giuliana Antolovich, MBBS, FRACP, PhD, is a Consultant Pediatrician at the Royal Children's Hospital Melbourne. She is also an Honorary Fellow at Murdoch Children's Research Institute and Senior Fellow with the Department of Paediatrics, University of Melbourne, Victoria, Australia.