# Evidence-Based Classification, Assessment, and Management of Pain in Children with Cerebral Palsy: A Structured Review

## TL;DR

Pain in children with cerebral palsy is common and complex, requiring personalized, interdisciplinary care and better diagnostic tools.

## Contribution

This structured review identifies evidence-based strategies and highlights gaps in pain classification and management for children with cerebral palsy.

## Key findings

- Pain in children with cerebral palsy is multifactorial and often under-recognized due to complex mechanisms.
- Multimodal strategies combining physical, pharmacological, and psychosocial interventions are supported by evidence.
- There is a need for standardized protocols and high-quality clinical trials to improve pain management practices.

## Abstract

What are the main findings?
Pain in children with cerebral palsy is highly prevalent, multifactorial, and often under-recognised, with diagnostic challenges linked to complex underlying mechanisms.Evidence supports multimodal, personalised management strategies that combine physical, pharmacological, and psychosocial interventions within an interdisciplinary framework.

Pain in children with cerebral palsy is highly prevalent, multifactorial, and often under-recognised, with diagnostic challenges linked to complex underlying mechanisms.

Evidence supports multimodal, personalised management strategies that combine physical, pharmacological, and psychosocial interventions within an interdisciplinary framework.

What is the implication of the main finding?
Effective pain management requires function-oriented goals, routine screening, and integration of family perspectives to ensure person-centred care.There is a pressing need for standardized protocols and high-quality clinical trials to improve evidence-based practice in this field.

Effective pain management requires function-oriented goals, routine screening, and integration of family perspectives to ensure person-centred care.

There is a pressing need for standardized protocols and high-quality clinical trials to improve evidence-based practice in this field.

Background and objectives: Pain is a prevalent and often underestimated issue in children with cerebral palsy (CP). When left untreated, pain can result in secondary complications such as reduced mobility and mental health challenges, which negatively impact social activity, participation, and overall quality of life. This review explores the complex mechanisms underlying pain in CP, highlights contributing factors, and places particular emphasis on diagnostic challenges and multimodal pain management strategies. Methods: Three scientific databases and, additionally, guideline repositories (2015–2025) were searched, yielding 1335 records. Following a two-step deduplication process, 850 unique items remained. Eighty-five full texts were assessed, of which 49 studies were included. These comprised one randomised controlled trial, 16 non-randomised studies, 12 systematic reviews, 8 non-systematic reviews, and 12 guidelines or consensus statements. Methodological quality was appraised with AMSTAR-2 where applicable, and Oxford levels of evidence were assigned to all studies. Results: Study quality was variable: 25% were systematic reviews, with only one randomised controlled trial. This literature identifies overlapping nociceptive, neuropathic, and nociplastic mechanisms of pain development. Classification remains inconsistent, though the International Classification of Diseases provides a useful framework. Only five assessment tools have been validated for this population. Interventions were reported in 45% of studies, predominantly pharmacological (27%) and physiotherapeutic (23%). Evidence gaps remain substantial. Conclusions: This review highlights the complexity of pain in children and adolescents with cerebral palsy and the need for a biopsychosocial approach to assessment and management. Evidence supports individualised, multimodal strategies integrating physical therapies, contextual supports, and, where appropriate, medical or surgical interventions. Clinical implementation remains inconsistent due to limited high-quality evidence, inadequate assessment tools, and poor interdisciplinary integration.