Luana Leonora Jensen1, Birgitte Klug Albertsen1, Henrik Schrّder1
1) Denmark
Aim: To assess the prevalence of neuropathic pain in children with acute lymphoblastic leukaemia (ALL)
Children with ALL experience pain throughout the treatment pathway. Neuropathic pain (NP) is related to chemotherapy and is often underestimated.
Methods: Thirty-five children with ALL, aged 1-16 years, 16 boys and 19 girls were treated from April 2012 to August 2014 at a Danish university hospital according to the Nordic Society of Pediatric Hematology/Oncology (NOPHO) 2008 protocol. Data on pain scores, functional symptoms and analgesic management were extracted retrospectively from electronic medical records. Pain scores were assessed daily using 2 scales: FLACC (Face, Legs, Activity, Cry, Consolability, 0-10) for children 1-5 years old and VAS (Visual Analogue Scale 0-10) for children older than 5 years. Mucositis and functional impairment (muscle strength, balance and numbness in the extremities) were assessed on 0-2 scale. The diagnosis of NP was established when at least three criteria were present: administration of chemotherapy drug vincristine; pain scores were greater than 5 in more than 50% of observations while patients were on morphine treatment; mucositis; functional impairment; adjuvant analgesic medication (antidepressants, gabapentin, methadone or ketamine).
Results: Twenty-eight children (80%) were diagnosed with NP. Five (14%) met five diagnostic criteria for NP, 13 (37%) met four criteria for NP and 10 children (29%) met three criteria for NP. Seven children (20%), who met less than three diagnostic criteria for NP, were younger than five years. Fifteen children (43%) had pain scores greater than 5 on morphine. Twenty-five children (76%) received antidepressants, 3 (9%) gabapentin, 3 (9%) methadone and 2 (6%) ketamine. All children received paracetamol.
Conclusion: Neuropathic pain is common in children undergoing treatment for ALL. The diagnose of NP is most frequently established in children older than five years.
Acknowledgments: Supported by Grant # number 2014-17 from the The Danish Childhood Cancer Foundation.
