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Neuropathic Pain in Pediatric Oncology: A Clinical Decision Algorithm
Doralina L Anghelescu1, Jessica Michala Tesney2
1Division of Anesthesia, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Mail Stop 130, 262 Danny Thomas Place, Memphis, TN, 38105-3678, USA. doralina.anghelescu@stjude.org.
Pediatric neuropathic pain management involves stepwise treatment, often combining gabapentinoids and tricyclic antidepressants as first-line options. Doses are typically modest, requiring prospective studies to optimize long-term analgesic efficacy.
Area of Science:
- Oncology
- Neurology
- Pain Management
Background:
- Pediatric neuropathic pain arises from diverse causes including chemotherapy, tumors, and surgery.
- Management principles mirror adult protocols but utilize conservative pediatric dosing.
Purpose of the Study:
- To outline current understanding and treatment strategies for neuropathic pain in pediatric oncology patients.
- To emphasize the need for optimized dosing and long-term study of interventions.
Main Methods:
- Review of existing treatment algorithms for adult neuropathic pain adapted for pediatric oncology.
- Discussion of first-line and adjuvant pharmacological options.
Main Results:
- Gabapentinoids and tricyclic antidepressants are recommended first-line therapies.
- Methadone, ketamine, and lidocaine serve as potential adjunctive treatments.
- Current pediatric dosing is often modest and rarely escalated.
Conclusions:
- A stepwise, combination approach is most effective for pediatric neuropathic pain.
- Long-term prospective studies are crucial for determining optimal, escalated dosing regimens and efficacy.
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