PURPOSE: A large prospective database from three Phase 3 studies allowed the study of spasticity-related pain (SRP) in pediatric cerebral palsy (CP). METHODS: Baseline (pretreatment) SRP data occurring during different activities in children/adolescents (aged 2-17 years, ambulant/nonambulant) with uni-/bilateral spastic CP was obtained using the Questionnaire on Pain caused by Spasticity (QPS; six modules specific to spasticity level [lower limb (LL) or upper limb (UL)] and type of respondent [child/adolescent, interviewer, or parent/caregiver]). RESULTS: At baseline, 331 children/adolescents with LL- and 155 with UL-spasticity completed at least one key item of their modules; LL/UL QPS modules of parent/caregivers were at least partially completed (key items) by 841/444 parents/caregivers. SRP with at least one activity at baseline was self-reported in 81.9% /69.7% (LLs/ULs) of children/adolescents with spasticity. Parents/caregivers observed LL/UL SRP behaviors in 85.9% /77.7% of their children, with multiple body regions affected. SRP negatively affected the great majority of the children in various ways. Child/adolescent-reported mean SRP intensity and parent/caregiver-observed mean SRP behavior frequencies were higher for LLs than ULs, and the level of SRP increased with more physically demanding activities. CONCLUSION: These data suggest SRP is more common and intense in pediatric CP than generally thought, emphasizing the need for effective, long-term pain management.

Beaumont Pediatric Physical Medicine and Rehabilitation Royal Oak Royal Oak MI USA

Department of Neurology Jagiellonian University Medical College Krakow Poland

Division of Paediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity Dr von Hauner Children's Hospital Ludwig Maximilian University of Munich Munich Germany

Faculty of Medicine and Dentistry and University Hospital Palacký University Olomouc Olomouc Czech Republic

Merz Therapeutics GmbH Frankfurt am Main Germany

Rady Children's Hospital San Diego CA USA

Shirley Ryan AbilityLab Northwestern Feinberg School of Medicine Chicago IL USA

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Spasticity-related pain in children/adolescents with cerebral palsy. Part 2: IncobotulinumtoxinA efficacy results from a pooled analysis