Pain Management After Pediatric Hematopoietic Cell Transplantation: A Narrative Review of Pain Phenotypes, Assessment, and Multimodal Care.

TL;DR

This narrative review describes pain phenotypes occurring across the pediatric HCT trajectory—from conditioning through survivorship—and recommends developmentally appropriate assessment and multimodal management integrating pharmacologic, nonpharmacologic, and interdisciplinary supportive care strategies.

Key findings

• Pain in pediatric HCT evolves across phases (conditioning, engraftment, recovery, survivorship) with multiple potential etiologies including mucosal injury, GVHD, infection, and medication toxicity
• Phenotype-based pain management combines opioids with adjuvant analgesics and nonpharmacologic strategies tailored to underlying pain mechanism
• Effective care requires interdisciplinary teams spanning oncology, palliative care, psychology, rehabilitation, pharmacy, and child life specialists
• Current pediatric HCT-specific pain guidance is limited; evidence is fragmented and future work requires standardized phenotyping and longitudinal outcome assessment

Why this matters at the bedside

Directly relevant to pediatric HCT teams and supportive care specialists. Provides framework for systematic pain phenotyping and multimodal management to guide clinical practice in a high-risk, complex population with limited specific guidelines.