Neuropathic Pain in patients with Cancer can be procedure-related


A wide range of different types of pain related to cancer therapy rather than the cancer itself – such as the neuropathic pain associated with the use of taxanes in as many as 30% of patients – has been identified.1

Pain can be related to surgery, radiotherapy, transplantation, chemotherapy, and hormonal therapy.2

 

Surgical pain syndromes
• Postamutation phantom pain • Postmastectomy pain
• Post-thoracotomy pain
Radiation-related pain syndromes
• Chest pain/tightness • Osteoradionecrosis
• Cystis • Pelvic fractures
• Enteritis • Peripheral nerve entrapment
• Fistula formation • Plexopathies
• Myelopathy • Proctitis
• Osteoporosis • Secondary malignancies
Stem cell transplantation-mediated chronic
graft-versus-host disease
• Scleroderma-like skin changes • Dyspareunia, vaginal pain
• Eye pain and dryness • Parestesias
• Oral pain and reduced jaw motion • Arthralgias, myalgias
• Dysuria
Chemotherapy-related pain syndromes
• Chemotherapy-induced
  peripheral neuropathy
• Osteonecrosis from
  corticosteroids
Hormonal therapy-related pain syndromes
• Osteoporotic compression fractures • Arthralgias

 

Procedure-related pain is important to take into consideration, particularly in children who are undergoing bone marrow aspiration, for example. It is important to adequately treat such pain.

Chemotherapy can lead to painful peripheral neuropathies, the incidence of which is increasing as more neurotoxic agents are introduced into clinical practice. The painful neuropathy can differ greatly in symptoms, intensity, and duration, depending on the agent used. The symptoms are usually bilateral, with a typical “stocking and glove” distribution. When symptoms are severe or irreversible, this can have serious clinical and quality-of-life implications for the patient.2

Progress is being made in identifying the possible mechanisms by which specific chemotherapeutic agents may cause neuropathic pain, but there is still much to learn. The proposed mechanisms highlighted in a review include the involvement of mitochondria, sodium channels, potassium channels, inflammation, oxidative stress, neuropeptides, nitric oxide, and caspases and calpains.3

Oral mucositis, an inflammation of the mucosa of the mouth, is sometimes caused by the systemic effects of chemotherapy, and can be a particular problem as the symptoms can include not only pain but also an inability to tolerate food or drink.

 

References

1 Lee JJ et al. Peripheral neuropathy induced by microtubule-stabilizing agents. J Clin Oncol. 2006; 24(10):1633-1642.
2 Paice JA et al. The management of cancer pain. Ca CA Cancer J Clin. 2011; 61:157-82.
3 Jaggi AS et al. Mechanisms in cancer-chemotherapeutic drugs-induced peripheral neuropathy. Toxicology. 2012;291:1-9.