Cerebral palsy patients at higher risk of receiving opioid prescriptions

The opioid crisis is an ongoing problem in the United States and certain populations are more susceptible to opioid exposure than others.

One of these populations? Adults with cerebral palsy.

Opioids are one approach to manage pain, but often work better for specific types of issues. Patients with cerebral palsy commonly experience pain, its complex, as it can last for different lengths of time (chronic, short-term) and have unique and many locations of where the pain stems from. For adult patients with cerebral palsy, opioids may not be as helpful to manage these types of pains.

Yet, recent research from the University of Michigan suggests that patients with cerebral palsy are more likely to be exposed to opioids and a higher volume of opioid prescriptions for a longer period of time. These results did not come as a surprise to the researchers.

“There is little research on the mechanisms of pain as individuals with cerebral palsy age throughout their life,” said Daniel Whitney, Ph.D., the lead author of the study and assistant professor of physical medicine and rehabilitation at Michigan Medicine. “Opioids may be prescribed at a higher rate for this population, but if it is not very effective at managing their types of pain, the risk-benefit ratio of opioid therapy seems unfavorably lopsided.”

Not much is known about how opioids impact the overall health of patients with cerebral palsy specifically. While opioids may help to manage short-term pain, they can also introduce side effects, such as mental health and substance abuse disorders, balance issues, and physical health problems.

“Opioids target specific pain mechanisms that can help with some elements of chronic pain, but there is a possibility that different routes for treatment can help target this pain more safely in terms of the person’s overall health,” said Ed Hurvitz, M.D., a physical medicine and rehabilitation specialist at Michigan Medicine and contributor to the paper.

Cerebral palsy populations are already medically vulnerable meaning they may be more likely to experience the negative side effects of opioids. The researchers hope that these findings prompt further research to investigate more appropriate opioid therapy and alternative routes to pain care for patients with cerebral palsy.

Alternatively, other common ways to treat this pain can vary from over-the-counter pain killers to specific stretches and exercises to help the areas of the body impacted. The researchers stress its important for providers to talk with their patients  about which methods are effective for them.

“The complex pain that patients with cerebral palsy experience can be treated in a variety of ways that have less side effects than opioids and create less exposure to the drug,” said Mark Peterson, Ph.D., M.S., FACSM, associate professor of physical medicine and rehabilitation at Michigan Medicine. “If you are prescribed opioids for pain and don’t feel that it is the right choice for you, it’s important to speak up to your care provider and search for other options.”

Additional authors: Daniel G. Whitney, Mark D. Peterson, and Edward A. Hurvitz

Funding: This work was supported by the National Institutes of Health (R01AR076994) and The American Occupational Therapy Foundation Health Services Research Grant.

Paper cited: “Population- and individual-level trajectories of opioid prescription patterns among adults with cerebral palsy: a retrospective cohort study,” National Public Health Emergency Collection. DOI: 10.1007/s11096-023-01553-5