Cerebral palsy medications given to adults may not match needs

Pain and symptom management are important parts of caring for adults living with cerebral palsy.

However, these patients are often treated with medications that may not align with the underlying type of symptom they’re experiencing.

This disconnect can lead to adults with cerebral palsy being prescribed medications that aren’t the correct treatment for the source of their concerns, creating patterns of people taking drugs that are unnecessary and could potentially worsen their health or create more complications down the line.

Examining the most common patterns of pain and symptom management strategies among adults living with cerebral palsy, University of Michigan Health professor of physical medicine and rehabilitation, Mark Peterson, Ph.D., M.S., FACSM, was able to observe if there are any differences by pain phenotype or co-occurring neurodevelopmental disorders and the medication that’s prescribed to treat them.

Looking at medication and therapy prescription estimates for pain and cerebral palsy symptom management, Peterson and team identified the most common pharmaceutical pain and symptom management interventions.

These included (from most prescribed to least prescribed) antiepileptics, antidepressants, benzodiazepines, nonsteroidal anti-inflammatories, non-perioperative opioids, antipsychotics, muscle relaxants, irritable bowel syndrome-specific drugs, clonidine, anticholinergics and botulinum toxin A injections.

Physical and occupational therapy, two primary interventions for pain and symptom management among children with CP, were prescribed for only 41% of the adult participants in the cohort.

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Unfortunately, not much has been known historically about the overall national prescribing patterns to treat pain and related symptoms in cerebral palsy, which could lead to adverse reactions.

“One of the most alarming discoveries from this research was the evidence that individuals with mixed pain phenotype presentations had a considerably greater pattern of prescriptions ranging from 60% for muscle relaxants to 80% for non-operative opioids,” said Peterson.

Peterson stresses that it’s important to use proper screening tools to better understand not only the type and/or origin of the presenting pain, but also how widespread the pain is.

“It’s vital to understand the potential links between opioid exposures and common symptoms or comorbidities of cerebral palsy, particularly respiratory disorders, psychiatric disorders, bowel disorders and fall-related fractures,” he said.

As Peterson continues to work to examine the ways pain and other symptoms can be properly addressed and treated for people with cerebral palsy, his team has created an overview with recommendations for pain treatment in adults with cerebral palsy. This is in conjunction with a large international project working to create the first clinical practice guideline for adults with cerebral palsy.

Additional authors: Heidi Haapala, M.D., Mary Schmidt, D.O., and Edward A. Hurvitz, M.D., from the Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI. Michael O’Leary, B.S., and Kathryn Ashbaugh, B.S., from the Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI. Meil Kamdar, M.A., from the Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI, the Center for Population Health Sciences, Stanford University, Stanford, CA, and the Cecil H. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC.

Funding/disclosures: This research was developed in part under a grant from the National Institutes of Health (grant no: #1R21DE032584-01).

Paper cited: “Medication and Therapy Profiles for Pain and Symptom Management Among Adults With Cerebral Palsy,” Mayo Clinic Proceedings: Innovations, Quality & Outcomes. DOI: 10.1016/j.mayocpiqo.2025100597