Dolor neuropático oncológico en población pediátrica

Neuropathic pain (NP) is defined by the Neuropathic Pain Special Interest Group (NeuPSIG) of the International Association for the Study of Pain (IASP) as “pain that arises as a direct consequence of an injury or disease affecting the somatosensory system”[]. The pathophysiology suggests that first-order neurons can increase their activation with cellular damage, increasing the number of sodium channels. Ectopic discharges are the result of increased depolarization at certain fiber sites, causing spontaneous pain and movement-related pain. Inhibitory circuits may be affected at the level of the dorsal horn or brainstem (or both), allowing pain impulses to travel unopposed. In addition, there may be alterations in the central processing of pain, thus generating greater sensitivity of spinal neurons and reduced activation thresholds. Another theory supports the idea of sympathetically maintained neuropathic pain[]. The purpose of this article is to carry out a narrative review of the literature available for the management of oncological neuropathic pain in the pediatric population, which represents a great challenge in clinical practice, because it is a clinical diagnosis that can be difficult, especially in younger children, due to the limitation in differentiating their characteristics; “burning”, “tingling”, “pins and needles”, “pulling”, “lancinating”. In turn, it requires multiple therapeutic strategies, with great limitations for standardization of the therapeutic approach. In pediatric oncology, the most frequently used chemotherapeutic agents such as vincristine, cisplatin and plaquitaxel can be causes of neuropathic pain that can become chronic for months and even years after therapy. Among other causes are solid structural lesions adjacent to nervous structures, post-surgical neuropathic pain, post-amputation phantom limb syndrome, autoimmune and degenerative neuropathic diseases. Likewise, patients in the end-of-life stage are usually related to complex circumstances and may include mixed nociceptive and neuropathic mechanisms.