Pediatric oncological pain: the influence on the posture of the head and the spine. A narrative review

Abstract

Pediatric oncological pain (OP) is a common condition in children with cancer, resulting in postural changes in the head and spine, which significantly impact their quality of life. Osteosarcoma is the most prevalent type of pediatric tumor affecting head and spine districts. Its exact cause is still unknown, although it may be attributed to DNA mutations in bone cells, either inherited or acquired after birth; it often leads to bone and muscle pain and discomfort. This can initiate a harmful cycle, including mood disorders like anxiety and depression and maladaptive thoughts. 

Conducting a thorough functional assessment of children with OP is crucial, involving clinical and psychological evaluations and multidisciplinary rehabilitative approaches. A physical evaluation of the head and spine primarily focuses on assessing motor abilities through inspection of joint mobility, muscle strength, palpation, reflexes, and sensitivity. 

This narrative review considered randomized clinical trials, observational and cohort studies, and case reports; studies that did not meet inclusion criteria were excluded; 41 studies were selected for this review. 

 A team of healthcare professionals, including orthodontists, physiat­rists, pediatricians, oncologists, and psychologists, collaboratively manage children with OP, aiming to minimize the physical and mental disability caused by OP. It is based on education, exercise therapy, and psychological approaches. 

Education should include proper ergonomic postural guidance for sitting and standing, pain education (neuroscience education), and management of mood disorders and maladaptive thoughts (cognitive-behavioral education).

Exercise therapy should focus on active postural correction, including exercises to counteract forward head posture, hyperkyphosis, and sway­back; strengthening exercises for spinal deep muscles; segmental stretching involving limbs and back muscles; and functional exercises.

Psychological therapy, particularly cognitive-behavioral therapy, involves cognitive restructuring, time-based activity pacing, relaxation techniques, and adaptive coping strategies. 

This review pro­vides a comprehensive overview of the clinical postural assessment of the head and spine, which is essential for planning effective multidisciplinary rehabilitative treatments.