Pharmacological approaches for management of neuropathic pain in children

Introduction: Neuropathic pain in children is a significant challenge to medical practice due to difficulties in diagnosis and limitations of pharmacological therapies. Aim: The review aimed to summarize the current knowledge about the pharmacological treatment of neuropathic pain in children and adolescents. Materials and Methods: Scientific publications from the last 15 years, including clinical cases, results of clinical trials and systematic reviews, were included in the current article. Resources such as PubMed and UpToDate were used for the search. It was performed by using the keywords “neuropathic pain in children”, “pediatric therapy”, “topical treatments”, “pharmacological therapy”, and “personalized treatment”. Results: The review briefly describes the main causes of neuropathic pain in children, the specific clinical signs of that kind of pain, and the diagnostic approaches in the pediatric population. Attention is paid to scales used in clinical practice for assessing pain intensity. The emphasis is set on pharmacological treatment with a focus on current data on the efficacy of main drug groups used for alleviation of neuropathic pain in children: gabapentinoids, which remain the most commonly used drugs; some antidepressants, particularly suitable for children with accompanying mood disorders; opioid analgesics, especially those with additional mechanisms of action; and lidocaine applied topically or in the form of intravenous infusions. In addition, the prospect of personalized treatment based on pain phenotyping through quantitative sensory testing is discussed. Conclusion: Management of neuropathic pain in children includes pharmacological and non-pharmacological methods. It requires an interdisciplinary and individualized approach and development of evidence-based therapeutic strategies.