title: Neuropathic pain referrals to a multidisciplinary pediatric cancer pain service.
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.
authors.affiliation: Division of Anesthesia and Pain Management Service, St. Jude Children's Research Hospital, Memphis, Tennessee. Electronic address: doralina.anghelescu@stjude.org.
authors.forename: Doralina L
authors.initials: DL
authors.lastname: Anghelescu
authors.affiliation: Division of Anesthesia and Pain Management Service, St. Jude Children's Research Hospital, Memphis, Tennessee.
authors.forename: Lane G
authors.initials: LG
authors.lastname: Faughnan
authors.affiliation: Department of Psychiatry, Dreyer Medical Center, Aurora, Illinois.
authors.forename: Mark P
authors.initials: MP
authors.lastname: Popenhagen
authors.affiliation: Division of Nursing Services, St. Jude Children's Research Hospital, Memphis, Tennessee.
authors.forename: Linda L
authors.initials: LL
authors.lastname: Oakes
authors.affiliation: Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee.
authors.forename: Deqing
authors.initials: D
authors.lastname: Pei
authors.affiliation: Department of Children's Anaesthesia, Women's and Children's Hospital, North Adelaide, Australia.
authors.forename: Laura L
authors.initials: LL
authors.lastname: Burgoyne
mesh_terms: D000293:Adolescent; D000328:Adult; D000700:Analgesics / Q000008:administration & dosage*; D002173:Cancer Care Facilities; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009369:Neoplasms / Q000150:complications*; D009437:Neuralgia / Q000188:drug therapy / Q000209:etiology / Q000451:nursing; D059408:Pain Management / Q000379:methods / Q000451:nursing; D010348:Patient Care Team; D010372:Pediatrics; D012017:Referral and Consultation; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000700:Analgesics