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Neuropathic pain and neurocognitive functioning in children treated for acute lymphoblastic leukemia
Marita Partanen1, Nicole M Alberts2, Heather M Conklin3
1Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.
Insights
Childhood acute lymphoblastic leukemia (ALL) survivors experiencing neuropathic pain showed worse memory and learning outcomes. Opioid treatment for pain further impacted neurocognitive performance, suggesting closer monitoring for these patients.
Area of Science:
- Pediatric Oncology
- Neuroscience
- Clinical Psychology
Background:
- Childhood acute lymphoblastic leukemia (ALL) survivors face neurocognitive deficits and pain.
- Pain may worsen cognitive impairments in these children.
- Contemporary ALL therapies are associated with these long-term effects.
Purpose of the Study:
- To investigate the relationship between neuropathic pain and neurocognitive outcomes in childhood ALL survivors.
- To assess the impact of pain characteristics and management on cognitive function.
- To identify risk factors for neurocognitive impairment post-ALL treatment.
Main Methods:
- 345 childhood ALL survivors from a clinical trial (NCT00137111) were assessed.
- Neurocognitive assessments included attention, learning, and memory measures at multiple time points.
- Neuropathic pain data (events, duration, severity) and pain management (opioids, gabapentin) were collected.
Main Results:
- 39% of survivors reported neuropathic pain during treatment.
- Survivors with pain exhibited greater memory impairments compared to those without pain.
- Increased pain events and opioid use were associated with poorer learning and memory performance.
Conclusions:
- Neuropathic pain is a potential risk factor for learning problems in childhood ALL survivors.
- Opioid treatment for pain may negatively affect neurocognitive outcomes.
- ALL survivors with pain require vigilant monitoring and potential interventions for neurocognitive deficits.
Abstract:
Children with acute lymphoblastic leukemia (ALL) often experience treatment-related neurocognitive deficits and significant pain. Pain may exacerbate these cognitive impairments. This study examined neuropathic pain and neurocognitive outcomes in survivors of childhood ALL treated with contemporary therapy on a clinical trial (NCT00137111). There were 345 survivors (45% female, M = 6.9 years at diagnosis) who completed neurocognitive assessments including measures of sustained attention, learning and memory, and parent ratings of attention during at least one of 4 time points: on-therapy (Induction and Reinduction), end of therapy, and 2 years post-therapy. At-risk performance was defined as a score at least 1SD below the age-adjusted mean. Data on neuropathic pain (events, duration, and severity according NCI Common Toxicity Criteria) and pharmacologic pain management (opioids and gabapentin) were ascertained. Results showed that 135 survivors (39%) experienced neuropathic pain during treatment. Compared with those without pain, survivors with pain had greater memory impairments at end of therapy (California Verbal Learning Test [CVLT]-Total, 24% vs 12%, P = 0.046). Within the pain group, survivors who experienced a greater number of pain events (CVLT-Total = -0.88, P = 0.023) and those who were treated with opioids (versus gabapentin) had poorer learning and memory performance (CVLT-Total = -0.73, P = 0.011; Short Delay = -0.57, P = 0.024; Long Delay = -0.62, P = 0.012; and Learning Slope = -0.45, P = 0.042) across time points. These are considered medium-to-large effects (SD = 0.45-0.88). Neuropathic pain may be a risk factor for learning problems after therapy completion, and treatment for pain with opioids may also adversely affect neurocognitive performance. Therefore, patients who experience pain may require closer monitoring and additional intervention for neurocognitive impairment.
