Autonomous nervous system regulation of pain in children with cerebral palsy.

: Children with cerebral palsy (CP) have increased pain sensitivity and recurrent pain episodes; however, pain is underreported in children with intellectual impairment. Cardiac autonomic regulation is imbalanced in chronic pain conditions and neurological disorders. This study aims at exploring the autonomous nervous system regulation of pain in children with CP compared with typically developing peers (TDP).: Heart rate variability (HRV) was recorded during 24 hours in 26 children with CP and 26 TDP, and examined offline at baseline (sleeping, seated rest) and during spontaneous pain events. Pain and fatigue, HRV indices (linear indices on time - IBI, SDNN, RMSSD - and frequency domains - high, low, and very low frequency - and non-linear indices - Hurst coefficient and multiscale entropy) were computed.: Children with CP showed comparable HRV during daily conditions and similar reductions after pain events than their TDP, regardless of their level of intellectual impairment. : Children with CP have an intact autonomic regulation in acute pain events. HRV could be an accurate pain biomarker in children with CP and intellectual disability.: Autonomic regulation in acute pain is efficient in children with cerebral palsy.Heart rate variability indices can be reliable pain biomarkers in intellectual impairment.