Cerebral Palsy Pain Negatively Affects Employment, Earnings

Patients with chronic pain from cerebral palsy have greater difficulty with employment and earnings.

Cerebral palsy (CP) pain can negatively affect earnings and even lower access to full-time employment, according to results of a longitudinal cohort study, published in the Disability and Health Journal.

Cerebral palsy pain is chronic and often develops with the disease. It is among the most common early-onset lifelong disabilities. Pain is also associated with reduced quality of life, poor sleep, and functional and social limitations.

This study focused on the impact that CP pain has on employment, earnings, and use of social welfare systems for individuals with the disease. Data were sourced from Sweden’s National Patient Register, Medical Birth Register, and the Swedish CP-Follow up Program and national register. Individuals (N=6899) diagnosed with the disease between 1990 and 2015 were evaluated for employment and pain outcomes. Pain was defined as having a diagnosis of pain or a dispensation for pain-related prescriptions in a given year.

The study population comprised 45.69% women, 2288 had mild and 1731 severe CP, 18.21% attended higher education, 16.14% were married or cohabitating, fewer than 5% had a child aged 0-3, 4-6, 7-10, or 11-15 years of age between 2006 and 2015, and 38.26% had cerebral palsy pain.

Pain treatment and management is clearly important to improve quality of life and pain and should be screened from an early age and actively managed throughout the life course.

The rate of pain was highest for women with severe CP (54.83%) and lowest for men with mild CP (24.65%). Stratified by time, the rate of pain decreased for those with mild CP from 30% in 2006-2010 to 28% in 2011-2015 whereas the prevalence increased for those with severe CP from 47% in 2006 to 50% in 2012.

The rate of employment was 29.62% overall and was higher for individuals with mild cerebral palsy (36.52%) than for those with severe disease (20.77%). The employment rate was also higher for men (32.14%) than women (26.62%).

Cerebral palsy pain is associated with a 7% decrease in employment overall or a 9% decrease in mild CP and 12% decrease in severe CP. Stratified by gender, pain associated with a 9% and 15% decrease for men and an 8% and 9% decrease for women with mild and severe CP, respectively.

Cerebral palsy pain is also associated with a 3% reduction in earnings overall or 2% and 4% for mild and severe CP and 4% and 2% among men and women, respectively.

Patients with cerebral palsy pain are 93% more likely to have leave due to sickness, according to the report. Individuals with pain are also 1% more likely to receive disability pensions and 15% less likely to receive unemployment benefits.

In a sensitivity analysis that used earnings thresholds, the association between cerebral palsy pain and employment was stronger at higher earnings thresholds.

The major limitation was the subjective definition of pain in this study.

“Pain treatment and management is clearly important to improve quality of life and pain and should be screened from an early age and actively managed throughout the life course,” the study authors advise.


Asuman D, Gerdtham U-G, Alriksson-Schmidt AI, Rodby-Bousquet E, Andersen GL, Jarl J. Pain and labour outcomes: a longitudinal study of adults with cerebral palsy in Sweden. Disabil Health J. 2023;101479. doi:10.1016/j.dhjo.2023.101479