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Neuropathic pain feature in cancer-induced bone pain: does it matter? a prospective observational study

  • 투고 : 2022.11.30
  • 심사 : 2023.02.25
  • 발행 : 2023.04.01

초록

Background: Cancer-induced bone pain (CIBP) is considered to have both nociceptive and neuropathic components. However, the prevalence, risk factors, and impact of the neuropathic components are yet poorly understood. Methods: We estimate the prevalence of neuropathic pain (NP) features in patients with CIBP at a tertiary care pain clinic setting using the Douleur Neuropathique 4 questionnaire and evaluate their associated factors and their impact after 4 weeks of treatment using the Brief Pain Inventory questionnaire and the Edmonton Symptom Assessment System. Results: A total of 133 patients were recruited. The estimated prevalence of NP was 30.8% (95% confidence interval: 23.6%-39.1%). Initially, the patients with NP had significantly higher average pain scores (6.00 vs. 5.05, P = 0.006), higher total interference scores (5.84 vs. 4.89, P = 0.033), and symptom distress scores (35.88 vs. 26.52, P = 0.002). After 4 weeks of treatment, patients in both groups reported significantly decreased pain intensity and improved quality of life. However, the patients with NP still reported significantly higher average pain (4.61 vs. 3.58, P = 0.048), trending toward higher total interference scores (3.52 vs. 2.99, P = 0.426), and symptom distress scores (23.30 vs. 20.77, P = 0.524). From multivariate analysis, the independent risk factors for NP were younger age, pain in the extremities, and higher average pain scores. Conclusions: NP are common in patients with CIBP. These conditions negatively affect pain intensity and the patient's quality of life before and after treatment.

키워드

과제정보

The authors thank Dr. Arunee Saengsanon for assisting with the data collection, and Ms. Nattaya Bunwatsana for assisting with the IRB processing.

참고문헌

  1. Coleman RE. Clinical features of metastatic bone disease and risk of skeletal morbidity. Clin Cancer Res 2006; 12(20 Pt 2): 6243s-9s. https://doi.org/10.1158/1078-0432.CCR-06-0931
  2. Coleman RE. Skeletal complications of malignancy. Cancer 1997; 80(8 Suppl): 1588-94. https://doi.org/10.1002/(SICI)1097-0142(19971015)80:8+<1588::AID-CNCR9>3.0.CO;2-G
  3. Hird A, Zhang L, Holt T, Fairchild A, DeAngelis C, Loblaw A, et al. Dexamethasone for the prophylaxis of radiation-induced pain flare after palliative radiotherapy for symptomatic bone metastases: a phase II study. Clin Oncol (R Coll Radiol) 2009; 21: 329-35. https://doi.org/10.1016/j.clon.2008.12.010
  4. Aielli F, Ponzetti M, Rucci N. Bone metastasis pain, from the bench to the bedside. Int J Mol Sci 2019; 20: 280.
  5. Peters CM, Ghilardi JR, Keyser CP, Kubota K, Lindsay TH, Luger NM, et al. Tumor-induced injury of primary afferent sensory nerve fibers in bone cancer pain. Exp Neurol 2005; 193: 85-100. https://doi.org/10.1016/j.expneurol.2004.11.028
  6. Mantyh PW. Cancer pain and its impact on diagnosis, survival and quality of life. Nat Rev Neurosci 2006; 7: 797-809. https://doi.org/10.1038/nrn1914
  7. Obata K, Yamanaka H, Fukuoka T, Yi D, Tokunaga A, Hashimoto N, et al. Contribution of injured and uninjured dorsal root ganglion neurons to pain behavior and the changes in gene expression following chronic constriction injury of the sciatic nerve in rats. Pain 2003; 101: 65-77. https://doi.org/10.1016/S0304-3959(02)00296-8
  8. Habberstad R, Hjermstad MJ, Brunelli C, Kaasa S, Bennett MI, Pardon K, et al. Which factors can aid clinicians to identify a risk of pain during the following month in patients with bone metastases? A longitudinal analyses. Support Care Cancer 2019; 27: 1335-43. https://doi.org/10.1007/s00520-018-4405-9
  9. Kerba M, Wu JS, Duan Q, Hagen NA, Bennett MI. Neuropathic pain features in patients with bone metastases referred for palliative radiotherapy. J Clin Oncol 2010; 28: 4892-7. https://doi.org/10.1200/JCO.2010.28.6559
  10. Lechner B, Chow S, Chow R, Zhang L, Tsao M, Danjoux C, et al. The incidence of neuropathic pain in bone metastases patients referred for palliative radiotherapy. Radiother Oncol 2016; 118: 557-61. https://doi.org/10.1016/j.radonc.2016.02.018
  11. Nakamura N, Takahashi O, Zenda S, Kawamori J, Ogita M, Onozawa M, et al. Neuropathic pain features in patients with bone metastases. Clin Oncol (R Coll Radiol) 2016; 28: 204-8. https://doi.org/10.1016/j.clon.2015.10.007
  12. Bouhassira D, Attal N, Alchaar H, Boureau F, Brochet B, Bruxelle J, 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
  13. Chaudakshetrin P. Validation of the Thai Version of Brief Pain Inventory (BPI-T) in cancer patients. J Med Assoc Thai 2009; 92: 34-40.
  14. Chinda M, Jaturapatporn D, Kirshen AJ, Udomsubpayakul U. Reliability and validity of a Thai version of the edmonton symptom assessment scale (ESAS-Thai). J Pain Symptom Manage 2011; 42: 954-60. https://doi.org/10.1016/j.jpainsymman.2011.02.020
  15. Chaudakshetrin P, Prateepavanich P, Chira-Adisai W, Tassanawipas W, Leechavengvongs S, Kitisomprayoonkul W. Cross-cultural adaptation to the Thai language of the neuropathic pain diagnostic questionnaire (DN4). J Med Assoc Thai 2007; 90: 1860-5.
  16. World Health Organization. WHO guidelines for the pharmacological and radiotherapeutic management of cancer pain in adults and adolescents. World Health Organization. 2018, pp 21-49.
  17. Falk S, Dickenson AH. Pain and nociception: mechanisms of cancer-induced bone pain. J Clin Oncol 2014; 32: 1647-54. https://doi.org/10.1200/JCO.2013.51.7219
  18. Jimenez-Andrade JM, Mantyh WG, Bloom AP, Ferng AS, Geffre CP, Mantyh PW. Bone cancer pain. Ann N Y Acad Sci 2010; 1198: 173-81. https://doi.org/10.1111/j.1749-6632.2009.05429.x
  19. Mantyh PW. Bone cancer pain: from mechanism to therapy. Curr Opin Support Palliat Care 2014; 8: 83-90. https://doi.org/10.1097/SPC.0000000000000048
  20. Zhu XC, Zhang JL, Ge CT, Yu YY, Wang P, Yuan TF, et al. Advances in cancer pain from bone metastasis. Drug Des Devel Ther 2015; 9: 4239-45.
  21. Yang G, Luo Y, Baad-Hansen L, Wang K, Arendt-Nielsen L, Xie QF, et al. Ethnic differences in orofacial somatosensory profiles-quantitative sensory testing in Chinese and Danes. J Oral Rehabil 2013; 40: 844-53. https://doi.org/10.1111/joor.12091
  22. Zajacova A, Grol-Prokopczyk H, Fillingim R. Beyond Black vs White: racial/ethnic disparities in chronic pain including Hispanic, Asian, Native American, and multiracial US adults. Pain 2022; 163: 1688-99. https://doi.org/10.1097/j.pain.0000000000002574
  23. Nekolaichuk CL, Fainsinger RL, Lawlor PG. A validation study of a pain classification system for advanced cancer patients using content experts: the Edmonton Classification System for Cancer Pain. Palliat Med 2005; 19: 466-76. https://doi.org/10.1191/0269216305pm1055oa
  24. Mulvey MR, Bennett MI, Liwowsky I, Freynhagen R. The role of screening tools in diagnosing neuropathic pain. Pain Manag 2014; 4: 233-43. https://doi.org/10.2217/pmt.14.8
  25. Mulvey MR, Boland EG, Bouhassira D, Freynhagen R, Hardy J, Hjermstad MJ, et al. Neuropathic pain in cancer: systematic review, performance of screening tools and analysis of symptom profiles. Br J Anaesth 2017; 119: 765-74. https://doi.org/10.1093/bja/aex175
  26. Bouhassira D. Neuropathic pain: definition, assessment and epidemiology. Rev Neurol (Paris) 2019; 175: 16-25. https://doi.org/10.1016/j.neurol.2018.09.016
  27. Forbes HJ, Thomas SL, Smeeth L, Clayton T, Farmer R, Bhaskaran K, et al. A systematic review and meta-analysis of risk factors for postherpetic neuralgia. Pain 2016; 157: 30-54. https://doi.org/10.1097/j.pain.0000000000000307
  28. Hebert HL, Veluchamy A, Torrance N, Smith BH. Risk factors for neuropathic pain in diabetes mellitus. Pain 2017; 158: 560-8. https://doi.org/10.1097/j.pain.0000000000000785
  29. Chartier SR, Mitchell SAT, Majuta LA, Mantyh PW. The changing sensory and sympathetic innervation of the young, adult and aging mouse femur. Neuroscience 2018; 387: 178-90. https://doi.org/10.1016/j.neuroscience.2018.01.047
  30. Steverink JG, Oostinga D, van Tol FR, van Rijen MHP, Mackaaij C, Verlinde-Schellekens SAMW, et al. Sensory innervation of human bone: an immunohistochemical study to further understand bone pain. J Pain 2021; 22: 1385-95. https://doi.org/10.1016/j.jpain.2021.04.006
  31. Gonzalez-Roldan AM, Terrasa JL, Sitges C, van der Meulen M, Anton F, Montoya P. Age-related changes in pain perception are associated with altered functional connectivity during resting state. Front Aging Neurosci 2020; 12: 116.
  32. Lautenbacher S, Peters JH, Heesen M, Scheel J, Kunz M. Age changes in pain perception: a systematicreview and meta-analysis of age effects on pain and tolerance thresholds. Neurosci Biobehav Rev 2017; 75: 104-13. https://doi.org/10.1016/j.neubiorev.2017.01.039
  33. Richebe P, Capdevila X, Rivat C. Persistent postsurgical pain: pathophysiology and preventative pharmacologic considerations. Anesthesiology 2018; 129: 590-607. https://doi.org/10.1097/ALN.0000000000002238
  34. Thapa P, Euasobhon P. Chronic postsurgical pain: current evidence for prevention and management. Korean J Pain 2018; 31: 155-73. https://doi.org/10.3344/kjp.2018.31.3.155
  35. Oostinga D, Steverink JG, van Wijck AJM, Verlaan JJ. An understanding of bone pain: a narrative review. Bone 2020; 134: 115272.
  36. Finnerup NB, Haroutounian S, Kamerman P, Baron R, Bennett DLH, Bouhassira D, et al. Neuropathic pain: an updated grading system for research and clinical practice. Pain 2016; 157: 1599-606. https://doi.org/10.1097/j.pain.0000000000000492
  37. Scholz J, Finnerup NB, Attal N, Aziz Q, Baron R, Bennett MI, et al.; Classification Committee of the Neuropathic Pain Special Interest Group (NeuPSIG). The IASP classification of chronic pain for ICD-11: chronic neuropathic pain. Pain 2019; 160: 53-9. https://doi.org/10.1097/j.pain.0000000000001365
  38. Shkodra M, Brunelli C, Zecca E, Formaglio F, Bracchi P, Lo Dico S, et al. Neuropathic pain: clinical classification and assessment in patients with pain due to cancer. Pain 2021; 162: 866-74. https://doi.org/10.1097/j.pain.0000000000002076
  39. Brunelli C, Bennett MI, Kaasa S, Fainsinger R, Sjgren P, Mercadante S, et al.; European Association for Palliative Care (EAPC) Research Network and International Association for the Study of Pain (IASP) Cancer Pain Special Interest Group. Classification of neuropathic pain in cancer patients: a Delphi expert survey report and EAPC/IASP proposal of an algorithm for diagnostic criteria. Pain 2014; 155: 2707-13. https://doi.org/10.1016/j.pain.2014.09.038
  40. Bennett MI. Effectiveness of antiepileptic or antidepressant drugs when added to opioids for cancer pain: systematic review. Palliat Med 2011; 25: 553-9. https://doi.org/10.1177/0269216310378546
  41. Nishihara M, Arai YC, Yamamoto Y, Nishida K, Arakawa M, Ushida T, et al. Combinations of low-dose antidepressants and low-dose pregabalin as useful adjuvants to opioids for intractable, painful bone metastases. Pain Physician 2013; 16: E547-52. https://doi.org/10.36076/ppj.2013/16/E547
  42. Tuchman M, Barrett JA, Donevan S, Hedberg TG, Taylor CP. Central sensitization and Ca(V)α2δ ligands in chronic pain syndromes: pathologic processes and pharmacologic effect. J Pain 2010; 11: 1241-9. https://doi.org/10.1016/j.jpain.2010.02.024