Neuropathic pain (NP) is a common complication associated with some types of childhood cancer, mainly due to nerve compression, chronic post-surgical pain, chemotherapy, and radiotherapy. NP is usually less responsive to traditional analgesics, and there is generally a lack of evidence on its management in cancer patients, leading to recommendations often based on clinical trials conducted on other forms of non-malignant NP. In pediatric oncology, managing NP is still very challenging for physicians. Different factors contribute to increasing the risk of undertreatment: (a) children may be unable to describe the quality of pain; therefore, the risk for NP to be underestimated or remain unrecognized; (b) specific tools to diagnose NP have not been validated in children; (c) there is a lack of randomized clinical trials involving children, with most evidence being based on case series and case reports; (d) most drugs used for adult patients are not approved for childhood cancers, and drug regulation varies among different countries; (e) recommendations for pediatric pain treatment are still not available. In this paper, a multidisciplinary team will review the current literature regarding children with cancer-related NP to define the best possible diagnostic strategies (e.g., clinical and instrumental tests) and propose a therapeutic care pathway, including both non-pharmacological and pharmacological approaches, which could help pediatricians, oncologists, neurologists, and pain therapists in designing the most effective multidisciplinary approach.
神经病理性疼痛是某些类型儿童癌症的常见并发症，主要源于神经压迫、慢性术后疼痛、化疗及放疗。传统镇痛药物对该类疼痛通常疗效有限，且目前普遍缺乏针对癌症患者神经病理性疼痛管理的循证依据，导致临床建议多基于非恶性神经病理性疼痛的临床试验数据。在儿科肿瘤学领域，神经病理性疼痛的管理对临床医生仍具重大挑战。多种因素增加了治疗不足的风险：(a) 儿童可能无法准确描述疼痛性质，导致神经病理性疼痛易被低估或漏诊；(b) 特异性神经病理性疼痛诊断工具尚未在儿童群体中得到验证；(c) 缺乏涉及儿童的随机临床试验，现有证据多基于病例系列和病例报告；(d) 多数成人用药未获批用于儿童癌症治疗，且各国药物监管政策存在差异；(e) 儿童疼痛治疗指南体系尚不完善。本文将通过多学科团队协作，系统回顾当前儿童癌症相关神经病理性疼痛的文献，旨在确立最优诊断策略（包括临床及器械检查），并提出涵盖非药物与药物干预的治疗路径，为儿科医师、肿瘤学家、神经科医师及疼痛治疗师构建高效的多学科诊疗方案提供参考。
The Challenge of Managing Neuropathic Pain in Children and Adolescents with Cancer
肿瘤(癌症)患者之家