Chronic lower back pain in adults with cerebral palsy: Stigma, anxiety, and physical decline.

Aim: To determine the biopsychosocial factors associated with pain interference and pain intensity in adults with cerebral palsy (CP) and chronic lower back pain (LBP).

Method: This study was a cross-sectional data analysis of a community survey examining function and chronic pain in adults with CP. We examined bivariate relationships and built two regression models with pain interference with general activities and pain intensity as the dependent variables and biopsychosocial factors as explanatory factors.

Results: We included 295 participants (75 males, 203 females, two transgender, 14 non-conforming) with CP and LBP in our analyses. The mean age was 43 years 2 months; 81% were ambulatory and pain was present for mean 17 years 11 months [SD 13 years 5 months]. Ordinary least squares regression models indicated greater pain interference with change in best motor function since childhood (95% confidence interval [CI] = 0.47-1.96; p = 0.002), stigma (95% CI = 0.02-0.15; p = 0.01), and higher anxiety (95% CI = 0.02-0.11; p = 0.01; n = 238; adjusted R² = 0.17); and greater pain intensity with lower income (95% CI = -1.07 to -0.19; p = 0.01), Hispanic or Latino ethnic group (95% CI = 0.06-2.17; p = 0.04), higher anxiety (95% CI = 0.01-0.06; p = 0.01), and less satisfaction with social roles (95% CI = -0.10 to -0.04; p < 0.001; n = 290; adjusted R² = 0.16).

Interpretation: These findings emphasize the importance of interpreting chronic pain in the context of biopsychosocial factors, particularly anxiety, stigma, ethnic group, income, satisfaction with social roles, and physical functional decline.