The Role of IR in Pediatric Pain and Palliation

Abstract

Pediatric chronic pain is a significant problem that is often underreported and therefore not always adequately addressed. Causes include anatomic variants, trauma, local inflammation, and malignancy. Nerve blocks and cryoneurolysis can aid as an adjunct to pain management for these patients and significantly improve their quality of life. This article will describe specific procedures in which interventional radiology can aid in several specific procedures for pediatric pain management: splanchnic cryoneurolysis, sphenopalatine ganglion nerve block/cryoneurolysis, inferior alveolar nerve block, intercostal cryoneurolysis, and cryoablation of painful bone metastases, notably in the setting of metastatic sarcoma.

Keywords

interventional radiology - pediatric - palliation - nerve block - cryoneurolysis

Publication History

Article published online:
09 June 2025

• References

• 1 Ruskin DA, Dentakos S, Craig S. et al. Don't judge a book by its cover: Exploring low self-reported distress and repressive coping in a pediatric chronic pain population. J Child Health Care 2023; 27 (04) 693-706
• 2 Goddard JM. Chronic pain in children and young people. Curr Opin Support Palliat Care 2011; 5 (02) 158-163
• 3 de Blécourt ACE, Schiphorst Preuper HR, Van Der Schans CP, Groothoff JW, Reneman MF. Preliminary evaluation of a multidisciplinary pain management program for children and adolescents with chronic musculoskeletal pain. Disabil Rehabil 2008; 30 (01) 13-20
• 4 Wren AA, Ross AC, D'Souza G. et al. Multidisciplinary pain management for pediatric patients with acute and chronic pain: a foundational treatment approach when prescribing opioids. Children (Basel) 2019; 6 (02) 33
• 5 Christiansen S, Pritzlaff S, Escobar A, Kohan L. A sudden shift for pain medicine fellowships - a recount of the 2024 match. Interventional Pain Med 2024; 3 (02) 100404
• 6 Manchikanti L, Pampati V, Falco FJE, Hirsch JA. Growth of spinal interventional pain management techniques: analysis of utilization trends and Medicare expenditures 2000 to 2008. Spine 2013; 38 (02) 157-168
• 7 Kato J, Gokan D, Ueda K, Shimizu M, Suzuki T, Ogawa S. Successful pain management of primary and independent spread sites in a child with CRPS type I using regional nerve blocks. Pain Med 2011; 12 (01) 174
• 8 Sheen S, Riazuddin I, Javed S. Suprascapular nerve peripheral nerve stimulation for pediatric cancer pain: a case series. Pain Manag (Lond) 2024; 14 (5-6): 247-250
• 9 Le-Short C, Katragadda K, Nagda N, Farris D, Gelter MH. Interventional pain management for the pediatric cancer patient: a literature review. Children (Basel) 2022; 9 (03) 389
• 10 Theriault CB, Burns T, Goldschneider K. et al. Pediatric pain physician workforce: an assessment of supply and demand. Front Pain Res (Lausanne) 2024; 5: 1390736
• 11 Okita M, Otani K, Gibo N, Matsui S. Systematic review and meta-analysis of celiac plexus neurolysis for abdominal pain associated with unresectable pancreatic cancer. Pain Pract 2022; 22 (07) 652-661
• 12 Goyal S, Kumar A, Goyal D. et al. Efficacy of splanchnic nerve neurolysis in the management of upper abdominal cancer pain: a systematic review and meta-analysis. Indian J Anaesth 2023; 67 (12) 1036-1050
• 13 Kapural L, Lee N, Badhey H, McRoberts WP, Jolly S. Splanchnic block at T11 provides a longer relief than celiac plexus block from nonmalignant, chronic abdominal pain. Pain Manag (Lond) 2019; 9 (02) 115-121
• 14 Yang H-J, Gil Y-C, Lee W-J, Kim T-J, Lee H-Y. Anatomy of thoracic splanchnic nerves for surgical resection. Clin Anat 2008; 21 (02) 171-177
• 15 Loukas M, Klaassen Z, Merbs W, Tubbs RS, Gielecki J, Zurada A. A review of the thoracic splanchnic nerves and celiac ganglia. Clin Anat 2010; 23 (05) 512-522
• 16 Gill A, Bodner J, Hawkins M. Abstract no. 64 Freeze the pain away: cryoneurolysis for pediatric and adolescent patients. J Vasc Interv Radiol 2024; 35: S29
• 17 Robbins MS, Robertson CE, Kaplan E. et al. The sphenopalatine ganglion: anatomy, pathophysiology, and therapeutic targeting in headache. Headache 2016; 56 (02) 240-258
• 18 Piagkou M, Demesticha T, Troupis T. et al. The pterygopalatine ganglion and its role in various pain syndromes: from anatomy to clinical practice. Pain Pract 2012; 12 (05) 399-412
• 19 Khalil H. A basic review on the inferior alveolar nerve block techniques. Anesth Essays Res 2014; 8 (01) 3-8
• 20 Lee CR, Yang HJ. Alternative techniques for failure of conventional inferior alveolar nerve block. J Dent Anesth Pain Med 2019; 19 (03) 125-134
• 21 Bhatia A, Gofeld M, Ganapathy S, Hanlon J, Johnson M. Comparison of anatomic landmarks and ultrasound guidance for intercostal nerve injections in cadavers. Reg Anesth Pain Med 2013; 38 (06) 503-507
• 22 Urch C. The pathophysiology of cancer-induced bone pain: current understanding. Palliat Med 2004; 18 (04) 267-274
• 23 Cai B, Nickman NA, Gaffney DK. The role of palliative external beam radiation therapy in boney metastases pain management. J Pain Palliat Care Pharmacother 2013; 27 (01) 28-34
• 24 Strander H, Turesson I, Cavallin-Ståhl E. A systematic overview of radiation therapy effects in soft tissue sarcomas. Acta Oncol 2003; 42 (5-6): 516-531
• 25 Kurup AN, Callstrom MR. Image-guided percutaneous ablation of bone and soft tissue tumors. Semin Intervent Radiol 2010; 27 (03) 276-284
• 26 Tomasian A, Jennings JW. Bone metastases: state of the art in minimally invasive interventional oncology. Radiographics 2021; 41 (05) 1475-1492
• 27 Kurup AN, Morris JM, Boon AJ. et al. Motor evoked potential monitoring during cryoablation of musculoskeletal tumors. J Vasc Interv Radiol 2014; 25 (11) 1657-1664
• 28 Prologo JD, Johnson C, Hawkins CM. et al. Natural history of mixed and motor nerve cryoablation in humans - a cohort analysis. J Vasc Interv Radiol 2020; 31 (06) 912-916.e1
• 29 Vikingstad EM, de Ridder GG, Glisson RR. et al. Comparison of acute histologic and biomechanical effects of radiofrequency ablation and cryoablation on periarticular structures in a swine model. J Vasc Interv Radiol 2015; 26 (08) 1221-1228.e1
• 30 Hawkins CM, Gill AE. Introduction to interventional radiology's role in palliative care for children with cancer: a COG Diagnostic Imaging Committee/SPR Oncology Committee White Paper. Pediatr Blood Cancer 2023; 70 (Suppl. 04) e30238
• 31 Cazzato RL, Buy X, Grasso RF. et al. Interventional radiologist's perspective on the management of bone metastatic disease. Eur J Surg Oncol 2015; 41 (08) 967-974