•Recognize the high prevalence of neuropathic pain in children with advanced serious diseases.•Describe the main causes of neuropathic pain in pediatric patients receiving palliative care.•Develop a step-by-step treatment approach for neuropathic pain in children. The majority of children with life-limiting conditions experience pain during their last weeks of life. Clinicians need to differentiate between somatic/acute, visceral, chronic, and neuropathic pain, as the analgesic management for each pain type differs. Emerging data reveal that neuropathic pain in children with advanced cancer and other progressive serious diseases is common, underrecognized, and undertreated. This session will review the pharmacological and integrative (nonpharmacological) management of neuropathic pain. This presentation will address indications, dosages, side effects, and interactions of a miscellaneous group of pharmacologic agents used to manage neuropathic pain in children. Current multimodal analgesia approaches include pharmacological, anesthetic, rehabilitative, and integrative (nonpharmacological) therapies. A step-by-step approach for analgesic and adjuvant medications, including NSAIDs, opioids, alpha-agonists, corticosteroids, antidepressants, gabapentinoids/antiepileptics, NMDA-receptor-channel blockers, general anesthetics, antispasmodics, sodium channel blockers, and atypical antipsychotics, for pediatric neuropathic pain management will be suggested. The importance of nerve blocks and neuroaxial anesthetic approaches will be stressed. Rehabilitative treatments, especially physical and occupational therapy, as well as integrative treatment modalities, such as acupressure, acupuncture, biofeedback, hypnosis, diaphragmatic breathing, aromatherapy, progressive muscle relaxation, and their role in state-of-the-art pain management will be discussed. Differentiating neuropathic pain from neuroirritability in nonverbal children poses a particular challenge for the palliative care clinician, and this session will briefly introduce some assessment and management options for neuroirritability.