Division of Anesthesia, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Mail Stop 130, 262 Danny Thomas Place, Memphis, TN, 38105-3678, USA.
Paediatr Drugs. 2019 Apr;21(2):59-70. doi: 10.1007/s40272-018-00324-4.
Neuropathic pain in pediatric oncology can be caused by distinct lesions or disease processes affecting the somatosensory system, including chemotherapy-related neuronal injury, solid tumor-related involvement of neural structures, post-surgical neuropathic pain-including phantom limb pain and pain after limb-sparing surgery-and the complex circumstances of neuropathic pain at the end of life. Treatment algorithms reflect the general treatment principles applied for adult neuropathic pain, but the dose regimens applied in children are modest and rarely escalated to the maximum doses to optimize analgesic efficacy. Pharmacological management of neuropathic pain should be based on a stepwise intervention strategy, as combinations of medications are the most effective approach. Gabapentinoids and tricyclic antidepressants are recommended as first-line therapy. Methadone, ketamine, and lidocaine may be useful adjuvants in selected patients. Prospective studies extended over a substantial length of time are recommended because of the nature of neuropathic pain as persistent, chronic pain and based on the need for sufficient time to escalate medication dose regimens to full analgesic efficacy.
儿科肿瘤中的神经性疼痛可由影响躯体感觉系统的不同病变或疾病过程引起，包括与化疗相关的神经元损伤、实体瘤相关的神经结构受累、手术后神经性疼痛（包括幻肢痛和保肢手术后疼痛）以及生命末期复杂的神经性疼痛情况。治疗方案反映了应用于成人神经性疼痛的一般治疗原则，但应用于儿童的剂量方案适度，很少增加到最大剂量以优化镇痛效果。神经性疼痛的药物治疗应基于逐步干预策略，因为联合用药是最有效的方法。加巴喷丁类药物和三环类抗抑郁药被推荐作为一线治疗药物。在选定的患者中，美沙酮、氯胺酮和利多卡因可能是有用的辅助药物。建议进行持续时间较长的前瞻性研究，这是因为神经性疼痛是持续性慢性疼痛，并且需要足够的时间来增加药物剂量方案以达到充分的镇痛效果。
