Refractory Cancer Pain in a Pediatric Patient With Advanced Malignant Peripheral Nerve Sheath Tumor: A Total Pain-Oriented Palliative Care Approach

Malignant peripheral nerve sheath tumors (MPNSTs) are a rare and aggressive form of pediatric sarcomas, which are often accompanied by uncontrolled, intense pain, especially during advanced cancer stages. Pediatric oncology pain is often multidimensional and entails physical, psychological, and social facets of distress. Here, we describe the case of an eight-year-old girl with metastatic MPNST with refractory mixed nociceptive and neuropathic pain, even with increased opioid therapy, add-on analgesics, palliative radiotherapy, and peripheral nerve blocks. The detailed palliative care plan, based on the total pain framework, covered not only the physical symptoms but also psychological distress, as well as family-related issues. Multimodal interventions in the form of constant subcutaneous infusions, psychiatric, and tunneled epidural analgesia ultimately managed the symptoms. This case highlights the importance of identifying and dealing with total pain in pediatric oncology. Interventional analgesic methods could be useful, but they are most useful when combined within an overall palliative care model that is based on comfort, dignity, and quality of life.