Precision and Partnership: A Multidisciplinary Evidence-Based Update for the Assessment and Management of Neuropathic Pain in Pediatric Populations
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Abstract:
This refresher course addresses the complex challenges of identifying and managing neuropathic pain in children and youth, a population for whom evidence-based guidelines are historically lacking. By integrating translational science with the most current multidisciplinary clinical expertise and lived experience, this session provides a "bench-to-bedside" framework for care and management of neuropathic pain in pediatric populations.
Dr. Michael Jankowski presents recent breakthroughs in glial-driven pain, specifically how Schwann cell signaling mediates mechanical hypersensitivity in neuropathic pain conditions including disorders like neurofibromatosis.
Dr. Suellen Walker introduces multimodal assessment strategies, including screening tools, quantitative sensory testing (QST), and genetic analysis, to improve neuropathic pain classification and inform management.
This refresher course features the perspective of Vina Mohabir who brings lived and living experience of neuropathic pain, situating assessment within the relationship between a young person and their care team — centring the outcomes that matter most to youth and families.
Following this collaborative foundation, Dr. Brittany Rosenbloom and Dr. Giulia Mesaroli will present psychological interventions and physical strategies tailored to specific pain phenotypes. Together, this approach aims to replace the traditional "trial and error" method with precision-based interdisciplinary care that reduces polypharmacy and optimizes functional outcomes for pediatric populations.
Educational objectives:
By the end of this course, participants will be able to:
- Understand the biological mechanisms and lived perspective of neuropathic pain.
- Evaluate assessment of neuropathic pain and evidence for pharmacological management.
- Describe the integration of psychological and physical therapy strategies into a comprehensive care plan for neuropathic pain in children and youth.
Speaker 1 - Michael Jankowski, PhD
Department of Anesthesia, Division of Pain Management
Cincinnati Children’s Hospital Medical Center
Title: Schwann Cells and Neuropathic Pain.
This talk will discuss the fundamental role of peripheral nervous system glial cells in nerve injury related pain. An overview of neuropathic pain will be presented along with how Schwann cells (SCs) in particular play a role in sensory modulation. Specifically, this session will highlight recent breakthroughs in how SCs release neurotrophic factors (e.g. glial cell line-derived neurotrophic factor, GDNF) to sensitize adjacent sensory neurons leading to pain-like behaviors. This work will be presented in the context of the tumor predisposition syndrome, neurofibromatosis 1, where SCs are thought to be a major facilitator of neuropathic pain like phenomena.
Speaker 2 – Suellen Walker, MD, MSc, PhD
Title: Assessment and current evidence for management of neuropathic pain in paediatric populations.
Description: Neuropathic pain in children can be severe and persistent, difficult to recognise and manage, and clinical presentations vary with age and the underlying condition. A multimodal approach to assessment, with evidence from clinical and research methodologies, will be discussed. Attendees will gain an understanding of a step-wise approach to the recognition and management of neuropathic pain.
Clinical history and screening tools underpin recognition of possible neuropathic pain. Quantitative sensory testing (QST) can identify the degree, distribution and profile of sensory changes. Genetic analysis is diagnostic for some neuropathic conditions that present in childhood and can inform management. Current evidence for pharmacological management will be outlined, but is based on limited numbers of paediatric studies and extrapolation from evidence in adults. Patient-and parent-reported outcome measures and multidisciplinary assessment highlight pain-related disability and co-morbidities, and inform the multi/interdisciplinary management of chronic pain.
Speaker #3 Vina Mohabir, MSc, PhD Student, Health Systems Research (Health Informatics),
Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto; Patient Partner and Trainee, iOUCH Pain Lab, Child Health Evaluative Sciences, SickKids Research Institute
Title: Nothing about us without us: lived experience and collaborative goal-setting in paediatric neuropathic pain
Description:
This talk positions the lived and living experience of neuropathic pain as central to its assessment and management. Drawing on both research and personal experience, the session considers how clinical assessment is experienced from a young person's perspective, and where formal assessment and everyday priorities diverge. Much of this divergence is relational. The therapeutic relationship, and in particular trust and the experience of being believed, shapes what a young person is willing to disclose, and consequently what an assessment is able to capture. Collaborative goal-setting is therefore foundational rather than supplementary. Meaningful treatment depends on a purpose co-developed with young people and their families. Care that overlooks this risks focusing on what is easiest to measure rather than what matters most to young people. Such partnership shifts practice from a trial-and-error approach toward care that is responsive, compassionate, respectful, and fit for a shared purpose. Attendees will gain practical strategies to elicit and act on patient-defined goals, and a stronger rationale for recognizing lived experience as a form of knowledge that sits alongside mechanistic and clinical evidence in paediatric neuropathic pain.
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Speaker #4. Dr. Brittany Rosenbloom
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Speaker #5 Dr. Giulia Mesaroli, PT, PhD
Physiotherapist and Post-doctoral Research Fellow
The Hospital for Sick Children
Title: Physical strategies to manage neuropathic pain in the pediatric population
Description: This presentation will first provide an overview of the theoretical foundations and key principles that underpin physical strategies for pediatric chronic pain management. Then, participants will be introduced to a range of treatment approaches, including physical activity and exercise, sensory-based treatments, and motor imagery interventions, with discussion of their proposed mechanisms of action and role in rehabilitation.
Building on this foundation, the session will explore the evidence and clinical application of these interventions in pediatric neuropathic pain populations. Attendees will gain a deeper understanding of how physical strategies can be integrated into comprehensive care plans to improve function, participation, and quality of life for children and adolescents experiencing neuropathic pain.
Michael Jankowski, MD
Professor
Cincinnati Children's Hospital
Dr. Jankowski is the Theodore W. Striker, MD Chair in Anesthesia Research, a Professor and Vice Chief for Research in the Department of Anesthesia at Cincinnati Children's Hospital. His research focuses on basic mechanisms of nociception and how these mechanisms change across the lifespan with a focus on neuroimmune and non-neuronal communication.
Giulia Mesalori
Physiotherapist, Researcher and Educator
The Hospital for Sick Children
Giulia Mesaroli is a physiotherapist, researcher, and educator with a focus on pediatric pain management. She works clinically as a physiotherapist in the Department of Rehabilitation Services at The Hospital for Sick Children. Her clinical and research interests include neuropathic pain, complex regional pain syndrome, and the use of digital technologies to assess and treat pediatric chronic pain within rehabilitation settings.
Vina Mohabir, MSc, PhD Student
Vina Mohabir, MSc, is a patient partner and PhD student in Health Systems Research at the Institute of Health Policy, Management and Evaluation, University of Toronto. She is a trainee in the iOUCH Pain Lab within Child Health Evaluative Sciences at SickKids Research Institute, where her work focuses on co-designing digital health tools with young people living with painful conditions alongside intersecting forms of discrimination. She brings research training together with lived and living experience of neuropathic and chronic pain to her advocacy, with a focus on what matters most to young people and their families.
Suellen Walker
Professor of Paediatric Pain Medicine
UCL GOS Institute of Child Health and Great Ormond Street Hospital
Suellen Walker is Professor of Paediatric Pain Medicine, UCL GOS Institute of Child Health and Great Ormond Street Hospital, London, UK. Current activities include paediatric pain clinical practice, and she is Principal Investigator in the UCL GOS ICH Paediatric Pain Research Group. Her research interests include the long-term impact of pain experience during childhood, and paediatric neuropathic pain. (https://profiles.ucl.ac.uk/303-suellen-walker).
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