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

Pain is a common and clinically significant complication of pediatric hematopoietic cell transplantation (HCT). It evolves across conditioning, engraftment, early recovery, and survivorship, and may result from mucosal injury, procedures, graft-versus-host disease (GVHD), infection, medication toxicity, immobility, and long-term complications. Pediatric HCT-specific guidance remains limited, so practice is often extrapolated from broader pediatric oncology, adult HCT, and supportive/palliative care literature. This narrative review summarizes major pain phenotypes after pediatric HCT and emphasizes developmentally appropriate, repeated assessment; phenotype-based pharmacologic management; and multimodal care integrating opioids, adjuvant analgesics, nonpharmacologic strategies, rehabilitation, child life, psychology, pharmacy, and palliative care. Evidence remains fragmented. Future work should prioritize standardized pain phenotyping, patient- and proxy-reported outcomes, longitudinal assessment of pain and function, and multicenter supportive-care pathways extending beyond acute transplant.