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Neuropathic pain referrals to a multidisciplinary pediatric cancer pain service
Doralina L Anghelescu1, Lane G Faughnan1, Mark P Popenhagen2
1Division of Anesthesia and Pain Management Service, St. Jude Children's Research Hospital, Memphis, Tennessee.
Insights
Pediatric cancer patients experience neuropathic pain (NP), often caused by treatment. This challenging condition requires complex management, including multiple medications and longer follow-up.
Area of Science:
- Pediatric Oncology
- Pain Management
- Neurology
Background:
- Neuropathic pain (NP) in pediatric cancer patients is not well-defined.
- NP can significantly impact quality of life and treatment outcomes in children with cancer.
Purpose of the Study:
- To characterize the prevalence, patient demographics, and management of NP in children with cancer.
- To compare NP patient characteristics with those of non-NP patients within a pediatric pain management service.
Main Methods:
- Retrospective review of patient data over a 3.5-year period.
- Analysis of referrals to a pediatric oncology center's pain management service.
- Inclusion of 56 patients diagnosed with NP.
Main Results:
- Neuropathic pain accounted for 15% of all referrals to the pain service.
- NP was more commonly caused by cancer treatment than the malignancy itself.
- NP patients required more clinical visits and longer follow-up durations compared to non-NP patients.
- Pharmacological management was complex, often involving three medications, with non-pharmacological approaches used in 57.6% of cases.
Conclusions:
- Neuropathic pain is a significant and complex issue in pediatric cancer care.
- Effective management requires a multidisciplinary approach, including pharmacologic and non-pharmacologic interventions.
- Further research is needed to optimize NP treatment strategies in this population.
Abstract:
Neuropathic pain (NP) in children with cancer is not well characterized. In a retrospective review of patient data from a 3.5-year period, we describe the prevalence of NP and the characteristics, duration of follow-up, and interventions provided for NP among patients referred to a pediatric oncology center's pain management service. Fifteen percent (66/439) of all referrals to our pain service were for NP (56/323 patients [17%]; 34 male, 22 female). The NP patient group had 1,401 clinical visits (778 inpatient visits [55.5%] and 623 outpatient visits [44.5%]). Patients with NP had a significantly greater mean number of pain visits per consultation (p = .008) and significantly more days of pain service follow-up (p < .001) than did other patients. The most common cause of NP was cancer treatment rather than the underlying malignancy. Pharmacologic management of NP was complex, often comprising three medications. Nonpharmacologic approaches were used for 57.6% of NP referrals. Neuropathic pain is less frequently encountered than non-NP in children with cancer; nevertheless, it is more difficult to treat, requiring longer follow-up, more clinical visits, complex pharmacologic management, and the frequent addition of nonpharmacologic interventions.
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