Diagnosis and management of pediatric neuropathic pain: Challenges and recent advances

Abstract

Background: Neuropathic pain in pediatric populations remains underdiagnosed and undertreated due to diagnostic challenges and limited evidence-based interventions. Objective: To retrospectively analyze diagnostic approaches, management strategies, and clinical outcomes in pediatric patients with neuropathic pain over a 5-year period. Methods: Chart review of 247 pediatric patients (ages 2-18 years) diagnosed with neuropathic pain at tertiary care centers between 2018-2023. This retrospective multicenter study from four tertiary hospitals in the Kingdom of Saudi Arabia (KSA) analyzes diagnostic approaches, management strategies, and clinical outcomes over five years. Data collected included demographics, pain etiology, diagnostic methods, pharmacological and non-pharmacological interventions, and treatment outcomes. Results: Cancer-related neuropathy (28.3%) and complex regional pain syndrome (24.7%) were the most common etiologies. Diagnosis relied primarily on clinical assessment (91.5%), with limited use of quantitative sensory testing (12.6%). First-line pharmacotherapy included gabapentin (63.2%) and amitriptyline (41.7%). Multidisciplinary management achieved significant pain reduction (mean NRS decrease 3.8 points, p < 0.001) compared to pharmacotherapy alone (1.9 points, p=0.02). Conclusion: Pediatric neuropathic pain management remains challenging with significant variability in diagnostic approaches and treatment protocols. Multidisciplinary care demonstrates superior outcomes.