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Neuropathic pain and neurocognitive functioning in children treated for acute lymphoblastic leukemia
Pain ( IF 7.4 ) Pub Date : 2022-06-01 , DOI: 10.1097/j.pain.0000000000002485
Marita Partanen 1 , Nicole M Alberts 2 , Heather M Conklin 3 , Kevin R Krull 3 , Ching-Hon Pui 3 , Doralina A Anghelescu 3 , Lisa M Jacola 3
Affiliation  

Children with acute lymphoblastic leukemia (ALL) often experience treatment-related neurocognitive deficits and significant pain. Pain may exacerbate these cognitive impairments. This study examined neuropathic pain and neurocognitive outcomes in survivors of childhood ALL treated with contemporary therapy on a clinical trial (NCT00137111). There were 345 survivors (45% female, M = 6.9 years at diagnosis) who completed neurocognitive assessments including measures of sustained attention, learning and memory, and parent ratings of attention during at least one of 4 time points: on-therapy (Induction and Reinduction), end of therapy, and 2 years post-therapy. At-risk performance was defined as a score at least 1SD below the age-adjusted mean. Data on neuropathic pain (events, duration, and severity according NCI Common Toxicity Criteria) and pharmacologic pain management (opioids and gabapentin) were ascertained. Results showed that 135 survivors (39%) experienced neuropathic pain during treatment. Compared with those without pain, survivors with pain had greater memory impairments at end of therapy (California Verbal Learning Test [CVLT]-Total, 24% vs 12%, P = 0.046). Within the pain group, survivors who experienced a greater number of pain events (CVLT-Total = −0.88, P = 0.023) and those who were treated with opioids (versus gabapentin) had poorer learning and memory performance (CVLT-Total = −0.73, P = 0.011; Short Delay = −0.57, P = 0.024; Long Delay = −0.62, P = 0.012; and Learning Slope = −0.45, P = 0.042) across time points. These are considered medium-to-large effects (SD = 0.45-0.88). Neuropathic pain may be a risk factor for learning problems after therapy completion, and treatment for pain with opioids may also adversely affect neurocognitive performance. Therefore, patients who experience pain may require closer monitoring and additional intervention for neurocognitive impairment.



中文翻译:

急性淋巴细胞白血病治疗儿童的神经病理性疼痛和神经认知功能

患有急性淋巴细胞白血病 (ALL) 的儿童经常会出现与治疗相关的神经认知缺陷和严重疼痛疼痛可能会加剧这些认知障碍。本研究在一项临床试验 (NCT00137111) 中检查了接受当代疗法治疗的儿童 ALL 幸存者的神经性疼痛和神经认知结果。有 345 名幸存者(45% 为女性,诊断时 M = 6.9 岁)完成了神经认知评估,包括持续注意力、学习和记忆的测量,以及家长在至少 4 个时间点之一的注意力评级:治疗中(诱导和治疗期间)再诱导)、治疗结束和治疗后 2 年。有风险的表现被定义为比年龄调整平均值至少低 1SD 的分数。确定了神经性疼痛(根据 NCI 通用毒性标准的事件、持续时间和严重程度)和药物疼痛管理(阿片类药物和加巴喷丁)的数据。结果显示,135 名幸存者 (39%) 在治疗期间经历了神经性疼痛。与没有疼痛的幸存者相比,有疼痛的幸存者在治疗结束时有更大的记忆障碍(加州语言学习测试 [CVLT]-总计,24% vs 12%,P = 0.046)。在疼痛组中,经历更多疼痛事件的幸存者(CVLT-Total = -0.88,P = 0.023)和接受阿片类药物(与加巴喷丁相比)治疗的幸存者学习和记忆表现较差(CVLT-Total = -0.73) ,P = 0.011;短延迟 = -0.57,P = 0.024;长延迟 = -0.62,P = 0.012;学习斜率 = -0.45,P = 0.042)。这些被认为是中到大的影响(SD = 0.45-0.88)。神经性疼痛可能是治疗完成后出现学习问题的危险因素,阿片类药物治疗疼痛也可能对神经认知功能产生不利影响。因此,经历疼痛的患者可能需要对神经认知障碍进行更密切的监测和额外的干预。

更新日期:2022-05-31
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