Relaxation Training to Decrease Pain and Improve Function in Adolescents With Cerebral Palsy

Chronic pain is a serious problem in many youths with disabilities. There is a growing body
of research supporting the efficacy of relaxation training for reducing chronic pain in
adults. Given this evidence, there has been a growing interest in determining whether these
findings also generalize to youths with chronic pain. This study will address a significant
gap in the medical literature by examining the efficacy of relaxation training for providing
pain relief and improving function in youths with physical disabilities. The study will
evaluate the effects of relaxation training on global physiological arousal, pain-site
specific muscle tension, and perceived control over pain. Physiological arousal will be
assessed via hand temperature and galvanic skin response. Muscle tension will be assessed
via surface EMG biofeedback recordings before, during, and after each treatment session.
Self-efficacy concerning pain control will be assessed via a modified Survey of Pain
Attitudes and modified Coping Strategies Questionnaire.

Sixty youth (age range 10 to 20 years old) with spastic type cerebral palsy (CP) will be
randomly assigned to either the relaxation training group or a distraction control group.
Youths in the relaxation training group will be given eight sessions of autogenic relaxation
training and will be asked to practice relaxation at home using audio tapes. Youths in the
distraction control group will receive eight sessions of distracting story-telling and will
be asked to listen to age-appropriate audio tapes of stories at home. Study visits are
scheduled weekly for eight weeks. Average pain intensity will be assessed with a numerical
rating scale. Secondary outcome measures include psychological functioning and pain
interference with personal activities. Medical services utilization will be assessed by
asking the parent or guardian about any medications taken by the participant, any illnesses
or medical complications, any medical treatments received, and the frequency of health care
visits. Participants will be assessed at 1, 3, 6, 9, and 12 months after treatment.

Inclusion Criteria:

- Cerebral palsy

- Referred by the study physician

- Chronic cerebral palsy-related pain for at least 3 months prior to study entry. The
pain needs to have an average daily occurrence of 3 on a 0 to 10 scale, where 0 is no
pain and 10 is extreme pain.

- Primary language is English

Exclusion Criteria

- Acute painful conditions

- Cognitive impairment as determined by a score < 12 on the modified Mini-Mental Status
Exam