Non-pharmacological and non-surgical treatment of pain in children and adolescents with cerebral palsy: A scoping review

PURPOSE: To explore the existing literature on non-pharmacological and non-surgical pain management in children and adolescents with cerebral palsy (CP).

METHODS: Databases (Cochrane Library, PubMed MEDLINE, Ovid Embase, and PsycINFO) were systematically searched to identify literature on non-pharmacological and non-surgical interventions for relieving pain in children with CP or similar conditions.

RESULTS: Thirteen publications met the inclusion criteria. Based on study designs, the overall level of evidence of the included studies was low, justifying the use of a scoping review. Only three were randomized controlled trials. Pain reduction was reported in 8 of the 13 studies from following interventions: physiotherapy/rehabilitation, massage, cranial osteopathy, swimming and aquatics, and assistive devices. These complementary strategies should not omit conventional treatment, and a multidisciplinary approach using multifaceted treatment of pharmacological and non-pharmacological therapy is recommended to increase the pain-relieving effect.

CONCLUSION: The results indicate that physiotherapy, massage, swimming exercise, and various assistive devices can have pain-relieving effects. We found limited evidence on the topic of non-pharmacological and non-surgical treatment of pain in children with CP. Due to the lack of power in the included studies, no true evidence-based recommendations can be made from the collected articles; thus, further studies with larger cohorts and more power are needed to substantiate evidence-based treatment of pain in children and adolescents with CP.