Prevalence of Lower Back Pain Diagnosis and Injection Utilization are Lower in Patients with Cerebral Palsy

Background and/or Objectives: Non-specific lower back pain (LBP) is a major source of disability. Patients with cerebral palsy (CP) have musculoskeletal issues that may predispose them to chronic pain, but their LBP diagnosis rates, and treatment utilization remain unclear. This retrospective cohort study examines LBP prevalence and lumbar injection utilization in CP versus non-CP populations.

Design: A national administrative database (2010–2023 Q1) was used to identify CP and non-CP cohorts and further divided into those with and without LBP diagnoses. Statistical analyses compared diagnosis rates and lumbar injection utilization.

Setting : Data were obtained from the PearlDiver M170 administrative claims database.

Participants : A random sample of 600,000 patients was analyzed: 2,534 (0.42%) with CP and 597,466 (99.58%) without CP. Patients were further stratified based on the presence or absence of an LBP diagnosis.

Interventions: LBP diagnosis and lumbar injection utilization were assessed using ICD codes. CP and non-CP patients were matched 5:1 based on age, sex, and Elixhauser Comorbidity Index. Injection types (facet, transforaminal, caudal, interlaminar) were analyzed.

Main Outcome Measures: LBP diagnosis prevalence in CP vs. non-CP; Lumbar injection utilization in CP vs. non-CP; Injection type distribution in both groups.

Results: LBP was diagnosed in 171,305 (28.7%) of non-CP patients vs. 414 (16.3%) of CP patients (p < 0.001). After matching, CP patients had lower injection utilization (36 patients - 8.9%) vs. non-CP (270 patients - 13.3%) (p = 0.013). Injection type distribution was not significantly different.

Conclusions: CP patients were less likely to be diagnosed with LBP. It is unclear whether this reflects lower LBP incidence or a bias in evaluation and diagnosis. However, once those with LBP were identified and matched, those with CP were less likely to have lumbar injections in the management of their discomfort. Further research is needed to explore barriers to diagnosis and pain management access in CP patients.