147 - Management of Pain in Children with Severe Neurological Impairments within a complex care program: A retrospective study

Poster Number: 147
Publication Number: 147.305

Deena Hassan, The Hospital for Sick Children, Brampton, ON, Canada; Kayla Esser, The Hospital for Sick Children, Toronto, ON, Canada; Julia Orkin, The Hospital for Sick Children, Toronto, ON, Canada; Tim F. Oberlander, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada; Hal Siden, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada; Eyal Cohen, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada; Catherine Diskin, The Hospital for Sick Children, Toronto, ON, Canada

Background: Children with medical complexity (CMC) are characterized by high health care utilization, medical fragility, functional disability and/or dependence on medical technology, and often have severe neurological impairment (SNI), requiring substantial to total assistance with daily living activities. Pain is common among CMC with SNI, however there is limited evidence for the optimal approach to pain assessment and management in this population.

Objective: The objective was to describe the clinical characteristics, medication use and investigations undertaken in CMC with SNI with pain compared to CMC with SNI without pain.

Design/Methods: In this retrospective cohort study, the clinical records of 296 medical charts of CMC enrolled in a dedicated complex care program, aged 1-18 years, were screened for SNI. Two hundred and one CMC had SNI, and 66 of this group experienced pain. Twenty CMC with SNI and pain were randomly selected for study. An age- and sex-matched control group of CMC with SNI without pain was also identified. Clinical characteristics were captured for one year following the first mention of pain or irritability in the medical record, or following the initiation of gabapentin. Mann-Whitney U tests were conducted to compare the number of medications and phlebotomies between the two groups. Two-tailed significance was set at p≤.05.

Results: Each group included 9 females and 11 males, with a median age of 6 years (IQR 3.5-9). CMC with SNI and pain had diagnoses of cerebral palsy (25%), epilepsy (90%), gastroesophageal reflux disease (95%), hypertonia (25%), dystonia (55%), and constipation (55%). CMC with SNI without pain also had diagnoses of cerebral palsy (10%), epilepsy (60%), gastroesophageal reflux disease (65%), hypertonia (5%), dystonia (5%), and constipation (45%). CMC with SNI with pain were treated with anticonvulsants (90%), proton pump inhibitors (95%), anti-spasticity (45%), benzodiazepines (80%), and probiotics (40%). CMC with SNI without pain were also on anticonvulsants (45%), proton pump inhibitors (55%), anti-spasticity (0%), benzodiazepines (40%), and probiotics (5%). The median number of medications in CMC SNI with pain was greater than it was for CMC SNI without pain (13 vs. 7, p= 0.05). The median number of phlebotomies in CMC SNI with pain was greater than it was for CMC SNI without pain (26 vs. 4, p= 0.05).Conclusion(s): On average, CMC with SNI and pain are on 1.8 more medications and undergo 6.5 more phlebotomies compared with those without pain. Further research should explore the impact of these treatments on pain in CMC.
Deena Hassan CVDeenaHassan_CV_PAS.pdf