Diagnosis and Treatment of Chronic Neuropathic and Mixed Pain in Children and Adolescents: Results of a Survey Study amongst Practitioners.

Thomas de Leeuw,Dick Tibboel,Tjitske der Zanden,Saskia de Wildt,Simona Ravera,Florentia Kaguelidou,Donato Bonifazi,Adriana Ceci,Mariagrazia Felisi

doi:10.3390/children7110208

Abstract

Validated diagnostic tools to diagnose chronic neuropathic and mixed pain in children are missing. Therapeutic options are often derived from therapeutics for adults. To investigate the international practice amongst practitioners for the diagnosis and treatment of chronic, neuropathic pain in children and adolescents, we performed a survey study among members of learned societies or groups whose members are known to treat pediatric pain. The survey included questions concerning practitioners and practice characteristics, assessment and diagnosis, treatment and medication. We analyzed 117 returned questionnaires, of which 41 (35%) were fully completed and 76 (65%) were partially completed. Most respondents based the diagnosis of neuropathic pain on physical examination (68 (58.1%)), patient history (67 (57.3%)), and underlying disease (59 (50.4%)) combined. Gabapentin, amitriptyline, and pregabalin were the first-choice treatments for moderate neuropathic pain. Tramadol, ibuprofen, amitriptyline, and paracetamol were the first-choice treatments for moderate mixed pain. Consensus on the diagnostic process of neuropathic pain in children and adolescents is lacking. Drug treatment varies widely for moderate, severe neuropathic, and mixed pain. Hence, diagnostic tools and therapy need to be harmonized and validated for use in children.

Highlights

The diagnosis and treatment of chronic neuropathic and mixed pain in children and adolescents is very challenging for various reasons
Eye movement desensitization and reprocessing (EMDR). The results of this survey study give insight into the international practice amongst practitioners dealing with neuropathic and mixed chronic pain in children. It appears that specialists of various disciplines are involved in the treatment of chronic pain in children
There is a fairly large variation in the way practitioners establish the diagnosis of chronic neuropathic pain

Summary

Introduction

The diagnosis and treatment of chronic neuropathic and mixed pain in children and adolescents is very challenging for various reasons. Neuropathic pain caused by diabetic neuropathy, radiculopathy, and strokes is rare in children, whereas congenital and autoimmune disorders and metabolic diseases in childhood as causes for neuropathic pain are hardly seen in the adult population [2,3]. Children with chronic pain are treated by pediatric pain specialists and by other practitioners who might not consider the possibility of a neuropathic origin of the pain. It is important to consider the possibility of neuropathic pain or a neuropathic component in mixed pain, since the treatment is quite different from that for nociceptive or inflammatory pain. Severe and long-lasting pain problems in childhood might result in persistence of pain or development of other chronic pain states in adulthood [5,6]

Methods

Results

Conclusion