BOSTON — Pain frequently interferes with sleep in children and adolescents with physical disabilities, results of a study suggest.
Pain should be routinely assessed and managed to minimize the adverse effects it can have on patients and their caregivers, said Marilyn Wright of McMaster University and McMaster Children's Hospital, Hamilton, Ont.
The cross-sectional survey of 178 caregivers of children and adolescents with physical disabilities showed that up to half of those with certain disabilities experienced nighttime pain, and that this pain—and its effects on sleep—was associated with a number of sequelae in both patients and caregivers, she reported in a poster at the annual meeting of the American Academy for Cerebral Palsy and Developmental Medicine.
For example, 50% of the children and adolescents in the study with muscular dystrophy, 48% of those with cerebral palsy, 15% of those with developmental delay, and 15% of those with spina bifida experienced nighttime pain. The most common types of pain reported were muscle pain (18% of patients), joint pain (10% of patients), muscle spasms (9% of patients), and growing pains (7% of patients).
Among the factors significantly associated with pain in the children were waking during the night (9% reportedly wake up three or more times per night), the necessity of position change during the night, daytime irritability attributed to lack of sleep, and interference with school and social activities.
Caregivers also were affected. Nighttime pain experienced by a child was shown to be associated with caregiver daytime irritability and exhaustion attributed to lack of sleep; negative effects on caregivers' work outside the home; caregiver concern about the child's sleeping position; and concern about the negative effect of poor sleep on the general health of the child.
Furthermore, the children and adolescents who were reported as having nighttime pain that interfered with sleep were more compromised in their independent mobility, Ms. Wright reported.
Self-reports by 25 children and adolescents who were interviewed about nighttime pain, its effects on sleep, and sequelae of poor sleep showed trends similar to those seen with the data provided by caregivers, she noted.
The current study was undertaken following a prior finding that pain had a negative effect on sleep quality in children and adolescents with physical disabilities more often than in children without such disabilities (30% vs. 3%). With increasing attention to the effects of pain on sleep in this population, there has been greater awareness of the need for early intervention.
“Early and ongoing orthopedic surveillance is an integral part of preventing secondary impairments that can contribute to pain and interruption of sleep,” Ms. Wright concluded.
Attention to positioning throughout the day also can help reduce pain. At McMaster Children's Hospital, a “24-hour positioning program” is offered to parents and caregivers through workshops and home visits, as well as through educational materials. It addresses issues like pain, muscle integrity, muscle contracture, and mobility, she said in an interview.
The program focuses on positioning throughout the day and promotes supportive, safe, well-aligned, and comfortable sleep positioning in an effort to reduce pain and promote optimal sleep throughout the night, she said.