The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Neuropathic cancer pain: prevalence, pathophysiology, and management

  • Yoon, So Young (Division of Oncology, Department of Internal Medicine, Konkuk University School of Medicine) ;
  • Oh, Jeeyoung (Department of Neurology, Konkuk University School of Medicine)
  • Received : 2018.01.26
  • Accepted : 2018.05.07
  • Published : 2018.11.01
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Abstract

Neuropathic cancer pain (NCP) is caused by nerve damage attributable to the cancer per se, and/or treatments including chemotherapy, radiotherapy, and surgery; the prevalence is reported to be as high as 40%. The etiologies of NCP include direct nerve invasion or nerve compression by the cancer, neural toxicity, chemotherapy, and radiotherapy. NCP is subdivided into plexopathy, radiculopathy, and peripheral neuropathies, among several other categories. The clinical characteristics of NCP differ from those of nociceptive pain in terms of both the hypersensitivity symptoms (burning, tingling, and an electrical sensation) and the hyposensitivity symptoms (numbness and muscle weakness). Recovery requires several months to years, even after recovery from injury. Management is complex; NCP does not usually respond to opioids, although treatments may feature both opioids and adjuvant drugs including antidepressants, anticonvulsants, and anti-arrhythmic agents, all of which improve the quality-of-life. This review addresses the pathophysiology, clinical characteristics and management of NCP, and factors rendering pain control difficult.

Keywords

References

  1. van den Beuken-van Everdingen MH, de Rijke JM, Kessels AG, Schouten HC, van Kleef M, Patijn J. Prevalence of pain in patients with cancer: a systematic review of the past 40 years. Ann Oncol 2007;18:1437-1449. https://doi.org/10.1093/annonc/mdm056
  2. Oldenmenger WH, Sillevis Smitt PA, van Dooren S, Stoter G, van der Rijt CC. A systematic review on barriers hindering adequate cancer pain management and interventions to reduce them: a critical appraisal. Eur J Cancer 2009;45:1370-1380. https://doi.org/10.1016/j.ejca.2009.01.007
  3. Bennett MI, Rayment C, Hjermstad M, Aass N, Caraceni A, Kaasa S. Prevalence and aetiology of neuropathic pain in cancer patients: a systematic review. Pain 2012;153:359-365. https://doi.org/10.1016/j.pain.2011.10.028
  4. Nicholson B. Differential diagnosis: nociceptive and neuropathic pain. Am J Manag Care 2006;12(9 Suppl):S256-S262.
  5. Lema MJ, Foley KM, Hausheer FH. Types and epidemiology of cancer-related neuropathic pain: the intersection of cancer pain and neuropathic pain. Oncologist 2010;15 Suppl 2:3-8.
  6. Treede RD, Jensen TS, Campbell JN, et al. Neuropathic pain: redefinition and a grading system for clinical and research purposes. Neurology 2008;70:1630-1635. https://doi.org/10.1212/01.wnl.0000282763.29778.59
  7. Oosterling A, te Boveldt N, Verhagen C, et al. Neuropathic pain components in patients with cancer: prevalence, treatment, and interference with daily activities. Pain Pract 2016;16:413-421. https://doi.org/10.1111/papr.12291
  8. Oh SY, Shin SW, Koh SJ, et al. Multicenter, cross-sectional observational study of the impact of neuropathic pain on quality of life in cancer patients. Support Care Cancer 2017;25:3759-3767. https://doi.org/10.1007/s00520-017-3806-5
  9. Rayment C, Hjermstad MJ, Aass N, et al. Neuropathic cancer pain: prevalence, severity, analgesics and impact from the European Palliative Care Research Collaborative-Computerised Symptom Assessment study. Palliat Med 2013;27:714-721. https://doi.org/10.1177/0269216312464408
  10. Garzon-Rodriguez C, Lyras L, Gayoso LO, et al. Cancer-related neuropathic pain in out-patient oncology clinics: a European survey. BMC Palliat Care 2013;12:41. https://doi.org/10.1186/1472-684X-12-41
  11. Boland EG, Mulvey MR, Bennett MI. Classification of neuropathic pain in cancer patients. Curr Opin Support Palliat Care 2015;9:112-115. https://doi.org/10.1097/SPC.0000000000000136
  12. Fallon MT. Neuropathic pain in cancer. Br J Anaesth 2013;111:105-111. https://doi.org/10.1093/bja/aet208
  13. Urch CE, Dickenson AH. Neuropathic pain in cancer. Eur J Cancer 2008;44:1091-1096. https://doi.org/10.1016/j.ejca.2008.03.015
  14. Vecht CJ. Nociceptive nerve pain and neuropathic pain. Pain 1989;39:243-246. https://doi.org/10.1016/0304-3959(89)90012-2
  15. Seretny M, Currie GL, Sena ES, et al. Incidence, prevalence, and predictors of chemotherapy-induced peripheral neuropathy: a systematic review and meta-analysis. Pain 2014;155:2461-2470. https://doi.org/10.1016/j.pain.2014.09.020
  16. Sisignano M, Baron R, Scholich K, Geisslinger G. Mechanism-based treatment for chemotherapy-induced peripheral neuropathic pain. Nat Rev Neurol 2014;10:694-707. https://doi.org/10.1038/nrneurol.2014.211
  17. Park SB, Goldstein D, Krishnan AV, et al. Chemotherapy-induced peripheral neurotoxicity: a critical analysis. CA Cancer J Clin 2013;63:419-437. https://doi.org/10.3322/caac.21204
  18. Fernandes R, Mazzarello S, Majeed H, et al. Treatment of taxane acute pain syndrome (TAPS) in cancer patients receiving taxane-based chemotherapy: a systematic review. Support Care Cancer 2016;24:1583-1594. https://doi.org/10.1007/s00520-015-2941-0
  19. Loprinzi CL, Reeves BN, Dakhil SR, et al. Natural history of paclitaxel-associated acute pain syndrome: prospective cohort study NCCTG N08C1. J Clin Oncol 2011;29:1472-1478. https://doi.org/10.1200/JCO.2010.33.0308
  20. Reeves BN, Dakhil SR, Sloan JA, et al. Further data supporting that paclitaxel-associated acute pain syndrome is associated with development of peripheral neuropathy: North Central Cancer Treatment Group trial N08C1. Cancer 2012;118:5171-5178. https://doi.org/10.1002/cncr.27489
  21. Griffith KA, Zhu S, Johantgen M, et al. Oxaliplatin-induced peripheral neuropathy and identification of unique severity groups in colorectal cancer. J Pain Symptom Manage 2017;54:701-706. https://doi.org/10.1016/j.jpainsymman.2017.07.033
  22. Pachman DR, Qin R, Seisler DK, et al. Clinical course of oxaliplatin-induced neuropathy: results from the randomized phase III Trial N08CB (Alliance). J Clin Oncol 2015;33:3416-3422. https://doi.org/10.1200/JCO.2014.58.8533
  23. Ventzel L, Jensen AB, Jensen AR, Jensen TS, Finnerup NB. Chemotherapy-induced pain and neuropathy: a prospective study in patients treated with adjuvant oxaliplatin or docetaxel. Pain 2016;157:560-568. https://doi.org/10.1097/j.pain.0000000000000404
  24. Loprinzi CL, Maddocks-Christianson K, Wolf SL, et al. The paclitaxel acute pain syndrome: sensitization of nociceptors as the putative mechanism. Cancer J 2007;13:399-403. https://doi.org/10.1097/PPO.0b013e31815a999b
  25. Grisold W, Cavaletti G, Windebank AJ. Peripheral neuropathies from chemotherapeutics and targeted agents: diagnosis, treatment, and prevention. Neuro Oncol 2012;14 Suppl 4:iv45-iv54.
  26. Rivera E, Cianfrocca M. Overview of neuropathy associated with taxanes for the treatment of metastatic breast cancer. Cancer Chemother Pharmacol 2015;75:659-670. https://doi.org/10.1007/s00280-014-2607-5
  27. Finnerup NB, Haroutounian S, Kamerman P, et al. Neuropathic pain: an updated grading system for research and clinical practice. Pain 2016;157:1599-1606. https://doi.org/10.1097/j.pain.0000000000000492
  28. Bennett M. The LANSS Pain Scale: the leeds assessment of neuropathic symptoms and signs. Pain 2001;92:147-157. https://doi.org/10.1016/S0304-3959(00)00482-6
  29. Park C, Lee YW, Yoon DM, Kim DW, Nam DJ, Kim DH. Cross-cultural adaptation and linguistic validation of the Korean version of the Leeds assessment of neuropathic symptoms and signs pain scale. J Korean Med Sci 2015;30:1334-1339. https://doi.org/10.3346/jkms.2015.30.9.1334
  30. Bouhassira D, Attal N, Alchaar H, et al. Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4). Pain 2005;114:29-36. https://doi.org/10.1016/j.pain.2004.12.010
  31. Kim HJ, Park JH, Bouhassira D, et al. Validation of the Korean version of the DN4 diagnostic questionnaire for neuropathic pain in patients with lumbar or lumbar-radicular pain. Yonsei Med J 2016;57:449-454. https://doi.org/10.3349/ymj.2016.57.2.449
  32. Abdallah FW, Morgan PJ, Cil T, Escallon JM, Semple JL, Chan VW. Comparing the DN4 tool with the IASP grading system for chronic neuropathic pain screening after breast tumor resection with and without paravertebral blocks: a prospective 6-month validation study. Pain 2015;156:740-749. https://doi.org/10.1097/j.pain.0000000000000108
  33. Freynhagen R, Baron R, Gockel U, Tolle TR. PainDETECT: a new screening questionnaire to identify neuropathic components in patients with back pain. Curr Med Res Opin 2006;22:1911-1920. https://doi.org/10.1185/030079906X132488
  34. Cruccu G, Sommer C, Anand P, et al. EFNS guidelines on neuropathic pain assessment: revised 2009. Eur J Neurol 2010;17:1010-1018. https://doi.org/10.1111/j.1468-1331.2010.02969.x
  35. Rog DJ, Nurmikko TJ, Friede T, Young CA. Validation and reliability of the Neuropathic Pain Scale (NPS) in multiple sclerosis. Clin J Pain 2007;23:473-481. https://doi.org/10.1097/AJP.0b013e31805d0c5d
  36. Bouhassira D, Attal N, Fermanian J, et al. Development and validation of the neuropathic pain symptom inventory. Pain 2004;108:248-257. https://doi.org/10.1016/j.pain.2003.12.024
  37. Valeriani M, Pazzaglia C, Cruccu G, Truini A. Clinical usefulness of laser evoked potentials. Neurophysiol Clin 2012;42:345-353. https://doi.org/10.1016/j.neucli.2012.05.002
  38. Backonja MM, Attal N, Baron R, et al. Value of quantitative sensory testing in neurological and pain disorders: NeuPSIG consensus. Pain 2013;154:1807-1819. https://doi.org/10.1016/j.pain.2013.05.047
  39. Terkelsen AJ, Karlsson P, Lauria G, Freeman R, Finnerup NB, Jensen TS. The diagnostic challenge of small fibre neuropathy: clinical presentations, evaluations, and causes. Lancet Neurol 2017;16:934-944. https://doi.org/10.1016/S1474-4422(17)30329-0
  40. Chan AC, Wilder-Smith EP. Small fiber neuropathy: getting bigger! Muscle Nerve 2016;53:671-682. https://doi.org/10.1002/mus.25082
  41. Hershman DL, Lacchetti C, Dworkin RH, et al. Prevention and management of chemotherapy-induced peripheral neuropathy in survivors of adult cancers: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol 2014;32:1941-1967. https://doi.org/10.1200/JCO.2013.54.0914
  42. Freynhagen R, Bennett MI. Diagnosis and management of neuropathic pain. BMJ 2009;339:b3002. https://doi.org/10.1136/bmj.b3002
  43. Moore RA, Derry S, Aldington D, Cole P, Wiffen PJ. Amitriptyline for neuropathic pain in adults. Cochrane Database Syst Rev 2015;(7):CD008242.
  44. Smith EM, Pang H, Cirrincione C, et al. Effect of duloxetine on pain, function, and quality of life among patients with chemotherapy-induced painful peripheral neuropathy: a randomized clinical trial. JAMA 2013;309:1359-1367. https://doi.org/10.1001/jama.2013.2813
  45. Henry NL, Unger JM, Schott AF, et al. Randomized, multicenter, placebo-controlled clinical trial of duloxetine versus placebo for aromatase inhibitor-associated arthralgias in early-stage breast cancer: SWOG S1202. J Clin Oncol 2018;36:326-332.
  46. Durand JP, Deplanque G, Montheil V, et al. Efficacy of venlafaxine for the prevention and relief of oxaliplatin-induced acute neurotoxicity: results of EFFOX, a randomized, double-blind, placebo-controlled phase III trial. Ann Oncol 2012;23:200-205. https://doi.org/10.1093/annonc/mdr045
  47. National Comprehensive Cancer Network. NCCN guidelines version 1 [Internet]. Fort Washington (PA): NCCN, c2018 [cited 2018 May 16]. Available from: www.nccn.org.
  48. Mishra S, Bhatnagar S, Goyal GN, Rana SP, Upadhya SP. A comparative efficacy of amitriptyline, gabapentin, and pregabalin in neuropathic cancer pain: a prospective randomized double-blind placebo-controlled study. Am J Hosp Palliat Care 2012;29:177-182. https://doi.org/10.1177/1049909111412539
  49. de Andrade DC, Jacobsen Teixeira M, Galhardoni R, et al. Pregabalin for the prevention of oxaliplatin-induced painful neuropathy: a randomized, double-blind trial. Oncologist 2017;22:1154-e105. https://doi.org/10.1634/theoncologist.2017-0235
  50. Finnerup NB, Attal N, Haroutounian S, et al. Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. Lancet Neurol 2015;14:162-173. https://doi.org/10.1016/S1474-4422(14)70251-0
  51. Knezevic NN, Tverdohleb T, Nikibin F, Knezevic I, Candido KD. Management of chronic neuropathic pain with single and compounded topical analgesics. Pain Manag 2017;7:537-558. https://doi.org/10.2217/pmt-2017-0020

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