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Neuropathic pain syndromes
Source publication
Cancer-related neuropathic pain is common; it can be disease related or related to the acute or chronic effects of cancer treatment. For example, chemotherapy-induced peripheral neuropathy occurs in 90% of patients receiving neurotoxic chemotherapy. Cancer treatments have become more effective; patients are living longer with cancer and there are m...
Context in source publication
Context 1
... cancer-related neuropathic pain syndromes are outlined in Table 1. Neuropathic pain may be challenging therapeutically and have a substantial impact on the quality of life, sleep, and mood. Treatment is often difficult and may involve interven- tions distinct from those typically used for nociceptive pains. ...
Citations
... With the increasing number of cancer patients every year, the side effects caused by chemotherapy drugs have become the focus of medical workers. Chemotherapy-induced neuropathic pain seriously affects the quality of life of millions of individuals, while bringing a great economic burden worldwide (1,2). At present, opioids are the most widely used painkillers in clinical practice, but their side effects cannot be ignored (3). ...
Remifentanil‑induced hyperalgesia (RIH) is characterized by the emergence of stimulation‑induced pain, including phenomena such as allodynia and thermal hyperalgesia following remifentanil infusion. As a sequence‑specific DNA binding transcription factor, PAX6 positively and negatively regulates transcription and is expressed in multiple cell types in the developing and adult central nervous system. It was hypothesized that puerarin could relieve RIH via targeting PAX6 to regulate transcription of transient receptor potential cation channel subfamily V Member 1 (TRPV1). A total of 32 rats were randomly divided into five groups, namely control group, RI group, RI + 10 mg/kg puerarin group (RI + puerarin10), RI + 20 mg/kg puerarin group (RI + puerarin20), and RI + 40 mg/kg puerarin group (RI + puerarin40). Mechanical and thermal hyperalgesia were tested at ‑24, 2, 6, 24 and 48 h after remifentanil infusion. Following the sacrifice of rats after the last behavioral test, western blot was used to detect the expression levels of TRPV1 in the tissues; Immunofluorescence staining and western blotting were used to detect the expression of PAX6 in the spinal cord. PharmMapper and JASPAR were used to predict the binding sites of puerarin/PAX6/TRPV1. Chromatin immunoprecipitation‑PCR and dual luciferase reporter assay were used to verify the targeting relationship between PAX6 and TRPV1. Immunofluorescence was used to detect the expression levels of TRPV1 and p‑NR2B. The results revealed that puerarin (10, 20, 40 mg/kg) dose‑dependently reduced thermal and mechanical hyperalgesia from 2 to 48 h after remifentanil infusion. Remifentanil infusion remarkably stimulated the expression of phosphorylated (p‑)NR2B. Nevertheless, the increased amount of p‑NR2B by RIH was dose‑dependently suppressed by puerarin in rats. In conclusion, puerarin was revealed to attenuate postoperative RIH via targeting PAX6 to regulate the transcription of TRPV1.
... 14 These approaches have not been widely used in assessing cancer pain, especially because of limitations such as uncertainties on the relative significance of confirmatory tests, especially sensory signs assessment. 12 A Delphi expert survey study proposed a modified European Association for palliative care (EAPC)/IASP algorithm 7 on the application of the NeuPSIG criteria for cancer pain assessment. To the best of our knowledge, no experience on the use of the EAPC/IASP algorithm has been published to date. ...
... Disagreements in bold.NeuPSIG, Neuropathic Special Interest Group; NP, neuropathic pain; QST, quantitative sensory testing; S-LANSS, self-reported Leeds Assessment of Neuropathic Signs and Symptoms. adjuvant drugs.12 This study highlights the role of choosing adequate criteria for NcP diagnosis and their application in clinical practice. ...
Introduction
Better diagnosis and treatment of neuropathic cancer pain (NcP) remains an unmet clinical need. The EAPC/IASP algorithm was specifically designed for NcP diagnosis; yet, to date, there is no information on its application and accuracy.
Objectives
Our aim was to determine the accuracy of the EAPC/IASP algorithm compared with the Neuropathic Special Interest Group grading system (gold standard) and to describe patients' sensory profile with quantitative sensory testing (QST).
Methods
This is a cross-sectional observational study conducted in a palliative care and pain outpatient clinic. Patients with cancer pain intensity ≥3 (numerical rating scale 0–10) were eligible. The palliative care physician applied the EAPC/IASP algorithm as a grading system to diagnose probable or definite NcP, and an independent investigator applied the gold standard and performed the QST. Sensitivity and specificity of the EAPC/IASP algorithm were measured in comparison with the gold standard results. Kruskal–Wallis and unequal variance independent-samples t tests were used to compare the QST parameters in patients with and without NcP.
Results
Ninety-eight patients were enrolled from August 2020 to March 2023. Sensitivity and specificity for the EAPC/IASP algorithm were 85% (95% CI 70.2–94.3) and 98.3% (95% CI 90.8–100), respectively. Patients with NcP in contrast to patients without NcP showed cold hypoesthesia ( P = 0.0032), warm hypoesthesia ( P = 0.0018), pressure hyperalgesia ( P = 0.02), and the presence of allodynia ( P = 0.0001).
Conclusion
The results indicate a good performance of the EAPC/IASP algorithm in diagnosing NcP and the QST discriminated well between patients with and without NcP.
... The prevalence of anxiety disorders is reported to be even higher for those who have been living with cancer for more than 2 years, with 17.9% of survivors meeting diagnostic criteria for anxiety [5]. As cancer treatments have become more effective than in previous decades, there are more cancer survivors living longer with cancer [6], yet also living with side and late effects of treatment. ...
... Neuropathy is another common symptom of either cancer treatment or, less frequently, cancer itself and can be acute or chronic in nature [6]. There are a wide range of ways in which patients describe this experience, although peripheral neuropathy is often described as the sensation of shooting or stabbing pain and tingling or loss of feeling in the affected areas. ...
... There are a wide range of ways in which patients describe this experience, although peripheral neuropathy is often described as the sensation of shooting or stabbing pain and tingling or loss of feeling in the affected areas. This can impact many activities, such as walking, balance, and mood [6]. In patients receiving neurotoxic chemotherapy, such as platinum drugs, taxanes, vinca alkaloids, proteasome inhibitors, and immunomodulatory drugs, approximately 30%-40% of patients will develop chemotherapy-induced peripheral neuropathy (CIPN) [8]. ...
Background
Anxiety- and cancer-related neuropathy are two persistent effects related to treatment for cancer. Mindfulness meditation has been used with substantial impact as a nonpharmacologic intervention to mitigate side and late effects of treatment. Mobile apps are ubiquitous for most of the general population, yet have a particular relevance for cancer survivors, given that physical and geographic limitations can be present.
Objective
This study aims to describe an ongoing trial of the Mindfulness Coach mobile app for cancer survivors.
Methods
In this randomized waitlist controlled trial, cancer survivors experiencing anxiety- or cancer-related neuropathy (200 for neuropathy and 200 for anxiety) and who had finished primary cancer treatment were invited to participate. Data were collected at 3 time points regardless of randomization condition: baseline, 8 weeks, and 16 weeks. Both face-to-face and web-based recruitment strategies were used. The trial was opened for 2 separate primary outcomes (anxiety- or cancer-related neuropathy). The goal was not to compare these groups but to compare treatment and waitlist groups for each condition. In addition to evaluating the impact of mobile mindfulness on reported anxiety- or cancer-related neuropathy, other pain, fatigue, trauma, sleep, and satisfaction with the Mindfulness Coach app will also be assessed.
Results
Outcomes of the study are expected in early 2024.
Conclusions
Mindfulness meditation has become widely practiced, and the use of mobile technology has become ubiquitous. Finding ways to deliver mindfulness meditation to people who have been treated for cancer allows for the intervention to be accessible to a larger number of survivors. The results of this intervention could have implications for further understanding the impact of mindfulness meditation on 2 persistent side and late effects of treatment of cancer, namely anxiety- and cancer-related neuropathy.
Trial Registration
ClinicalTrials.gov NCT03581357; https://ClinicalTrials.gov/study/NCT03581357
International Registered Report Identifier (IRRID)
DERR1-10.2196/47745
... The number of patients being treated for cancer continues to grow [1], which presents a challenge to treatment centers, health and welfare systems, and to the patients themselves. The majority of cancer patients experience exhaustion and fatigue [2,3], as well as neuropathy [4,5], as a consequence of their treatments. These factors adversely impact their participation in daily activities and reduce their quality of life [6,7]. ...
Background
Exercise has shown positive effects on fatigue, exhaustion, neuropathy, and quality of life in cancer patients. While on-land exercises have been studied, the aquatic environment offers unique advantages. Water's density and viscosity provide resistance, enhancing muscle strength, while hydrostatic pressure improves venous return. This trial aims to investigate the effect of aquatic exercises on time to return to work, work hours, work-related difficulties, daily life activity and participation, quality of life, exhaustion, fatigue, and neuropathy among cancer patients, compared to on-land exercise intervention group and a non-exercise group.
Methods
This randomized controlled trial will include 150 cancer patients aged 18–65 years with stage III colon cancer or breast cancer patients with lymph node involvement. Participants in the aquatic exercise intervention group will undergo an 8-week, twice-weekly group-based Ai-Chi program, while the on-land exercise group will perform identical exercise. The control group will not engage in any exercise.
The primary outcome will be assessed using an employment barriers questionnaire, capturing return to work date and working hours and daily life participation and activity and quality of life. Secondary outcomes include exhaustion, fatigue, and neuropathy. Data will be collected at baseline, post-intervention (8 weeks), and at 3,12, and 24 months. Mixed variance analyses will explore relationships among groups and over time for independent variables, with separate analyses for each dependent variable.
Discussion
The potential benefits include an earlier return to work for patients, reducing their need for social and economic support. The study's implications on socio-economic policies are noteworthy, as a successful intervention could offer a cost-effective and non-invasive solution, improving patients' quality of life and increasing their participation in daily activities. This, in turn, could lead to a faster return to work, contributing to both personal well-being and broader societal interests by reducing reliance on social services.
Trial registration
The trial is registered at ClinicalTrials.gov NCT05427344 (22 June 2022).
... The management of cancer pain should be considered of the utmost importance as it affects the quality of life of the patient. 7 Originally intended to treat epilepsy, gabapentin was later found to be an effective neuropathic pain medication. Numerous neuropathic pain syndromes have been successfully treated with gabapentin. ...
Background and objectives
Arthralgia, myalgia, and neuropathic pain are the most common side effects observed due to paclitaxel chemotherapy. The aim of this study was to investigate the prophylactic role, maintenance, remission, and re-occurrence of arthralgia, myalgia, and neuropathic pain post-gabapentin therapy.
Methodology
This study was conducted in the Department of Oncology, Dhiraj Hospital, Vadodara with a sample of 51 patients. Newly detected cancer patients who observed arthralgia, myalgia, and neuropathic pain due to paclitaxel were taken and a baseline pain assessment was done using the Common Terminology Criteria for Adverse Events (CTCAE) and painDETECT questionnaire. Gabapentin was given in the first cycle after symptoms appeared and prophylactic treatment was given in the subsequent three cycles and evaluation of pain was done post-gabapentin therapy to assess the symptomatic as well as prophylactic effect.
Results
At baseline, neuropathic pain score was 22.7 ± 3.6 which reduced to 0.01 ± 0.14 on subsequent follow-ups. Grade 2 arthralgia, myalgia, and neuropathic pain were more observed at baseline which reduces to Grade 0 in the third cycle. The difference in baseline and post-gabapentin therapy was statistically analyzed by conducting t-test which showed p-value <0.00001 and t-value was less than −2 which indicated a statistically significant result.
Conclusion
This study shows that gabapentin reduces neuropathic pain. Prophylactic usage of gabapentin was highly effective at bringing about quick pain relief when compared to symptomatic treatment. In further follow-ups, it was noted that gabapentin maintained the impact throughout the cycles.
... Ağrı, palyatif bakım kanser hastası ve ailesini fiziksel, psikolojik ve mali yönden olumsuz etkileyen, palyatif bakımda en sık karşılaşılan ve yaşam kalitesini azaltan semptomlardan biridir. 23 Kanser hastalarının hastalık süreci boyunca orta veya kuvvetli düzeyde ağrı hissettikleri bildirilmektedir. 5,23 Kanser hastalarının yaşadığı ağrı artarak ilerler, zamanla psikolojik ve fizyolojik problemlere yol açar. ...
... 23 Kanser hastalarının hastalık süreci boyunca orta veya kuvvetli düzeyde ağrı hissettikleri bildirilmektedir. 5,23 Kanser hastalarının yaşadığı ağrı artarak ilerler, zamanla psikolojik ve fizyolojik problemlere yol açar. Kanser ağrısı bireyin yaşam kalitesini düşüren kısır bir döngü oluşturur. ...
... Cancer is the second leading cause of death globally, and it was responsible for an estimated 9.6 million deaths in 2018. 1 Treatment for some cancers has become more effective in recent years, with longer and increased survival. 2 However, disease-related symptoms, such as pain, poor appetite, sleeping disturbances, and depression, can cause poor quality of life (QoL). [2][3][4] Pain affects the majority of patients with advanced cancer. ...
... 2 However, disease-related symptoms, such as pain, poor appetite, sleeping disturbances, and depression, can cause poor quality of life (QoL). [2][3][4] Pain affects the majority of patients with advanced cancer. 5 Opioid-based pharmacotherapy is a main strategy in conventional management of pain in cancer patients. ...
... However, opioids do not always provide adequate pain relief, and they are also associated with bothersome side effects. 2,3 When conventional medicine does not relieve the pain adequately, other treatment options are sought. For that reason, cannabis products have attracted increasing attention among cancer patients receiving palliative care in the past decade, despite their limited clinical evidence regarding their effects and safety of cannabis, which also makes physicians reluctant to prescribe them. ...
Background: Cannabis may offer therapeutic benefits to patients with advanced cancer not responding adequately to conventional palliative treatment. However, tolerability is a major concern. Cognitive function is a potential adverse reaction to tetrahydrocannabinol containing regimens. The aim of this study was to test cognitive function in patients being prescribed dronabinol as an adjuvant palliative therapy.
Methods: Adult patients with advanced cancer and severe related pain refractory to conventional palliative treatment were included in this case-series study. Patients were examined at baseline in conjunction with initiation of dronabinol therapy and at a two-week follow-up using three selected Wechsler's adult intelligence scale III neurocognitive tests: Processing Speed Index (PSI), Perceptual Organization Index (POI), and Working Memory Index (WMI). Patients were also assessed using pain visual analog scale, Major Depression Inventory, and Brief Fatigue Inventory.
Results: Eight patients consented to take part in the study. Two patients discontinued dronabinol therapy, one due to a complaint of dizziness and another critical progression of cancer disease, respectively. The remaining six patients were successfully treated with a daily dosage of 12.5 mg dronabinol (p = 0.039). PSI (p = 0.020), POI (p = 0.034.), and WMI (p = 0.039).
Conclusions: Cognitive function improved in this group of patients with advanced cancer in conjunction with low-dose dronabinol therapy. The cause is likely multifactorial including reported relief of cancer-associated symptoms. Further clinical investigation is required.
... In the context of the treatment, chemotherapy is considered a cornerstone of breast cancer intervention but causes adverse events that are significantly harmful, including chemotherapy-induced peripheral neuropathy (CIPN). Studies have revealed varying rates of CIPN prevalence over time following chemotherapy, with rates of 68.1% in the first month, 60.0% at three months, and 30.0% at six months or more, potentially reaching as high as 90% in certain cases (Fallon, 2013;Seretny et al., 2014). In BC, over 80% of patients continue to endure persistent CIPN for up to three years following their treatment completion (Rivera et al., 2018). ...
Breast cancer (BC) affects one in three women in the United States, making it the second most common cancer among females; a new woman is diagnosed with the disease every two minutes (Giaquinto et al., 2022). In the context of the treatment, chemotherapy is considered a cornerstone of breast cancer intervention but causes adverse events that are significantly harmful, including chemotherapy-induced peripheral neuropathy (CIPN). Studies have revealed varying rates of CIPN prevalence over time following chemotherapy, with rates of 68.1% in the first month, 60.0% at three months, and 30.0% at six months or more, potentially reaching as high as 90% in certain cases (Fallon, 2013; Seretny et al., 2014). In BC, over 80% of patients continue to endure persistent CIPN for up to three years following their treatment completion (Rivera et al., 2018). Clinically, CIPN predominantly affects sensory functions, resulting in numbness, tingling, and impaired sensation, usually presented in a stocking and glove pattern (Zajaczkowska et al., 2019). Although motor symptoms are less common than sensory symptoms, they often appear as distal weakness in hands and feet, leading to difficulties with walking, maintaining balance, carrying objects, and impaired overall body performance. As a result, this can impact BC patients' quality of life and safety and increase the likelihood of falling by three times (Gewandter et al., 2013; Kolb et al., 2016). The impact of CIPN also extends to inducing general body fatigue among BC women, with an incidence rate reaching up to 61.4%, leading to extensive long-term effects on physical and social aspects of daily routines (Schmidt et al., 2012).
... 9 In addition to the painful feelings, RRNP produces psychological and emotional disturbances that jeopardise quality of life. 10 There are few effective treatments for RRNP. Previous studies have shown that some analgesics such as amitriptyline, carbamazepine, and non-steroidal antiinflammatory drugs (NSAIDs) are ineffective for RRNP. ...
Introduction
Radiotherapy-related neuropathic pain (RRNP) is one of the most distressing complications after radiotherapy for head and neck cancers. Drug therapy is not sufficiently effective and has limitations in terms of dose titration period and side effects. Transcutaneous auricular vagus nerve stimulation (taVNS), which stimulates the auricular branches of the vagus nerve through electrical impulses, has been proven to have analgesic effects in certain diseases. However, it is unknown whether taVNS can relieve RRNP.
Methods and analysis
This is a multicentre, randomised, double-blind, parallel, sham-controlled trial. We will include adult patients newly diagnosed with neuropathic pain after radiotherapy for head and neck cancers. One hundred and sixteen individuals will be recruited and randomly assigned in a 1:1 ratio to receive taVNS or sham stimulation. The interventions will last for 7 days, twice daily for 30 min each. The primary efficacy outcome is pain reduction on day 7. The secondary outcomes are changes in functional interference, psychological distress, fatigue, quality of life and serum inflammatory factors. The study may provide a new early intervention strategy for RRNP among patients with head and neck cancers.
Ethics and dissemination
This study has been approved by the Medical Research Ethics Committee of Sun Yat-sen University (SYSKY-2022-109-01) and will be conducted in strict accordance with the Declaration of Helsinki. Ethical approvals will be obtained separately for all centres involved in the study. Study results will be published in peer-reviewed academic journals. The database of the study will be available from the corresponding author on reasonable request.
Trial registration number
NCT05543239
... Cancer-related neuropathic pain is common and can be disease-related or related to the acute or chronic effects of cancer treatment [15]. According to Sen and Uzunhan, out of 160 patients monitored for childhood malignancies, 16% (n = 26) developed neuropathic pain [16]. ...
Objectives
A multimodal approach to pain management, including potential interventional techniques, is suggested to achieve adequate pain control. This study discusses the techniques and medications employed to manage pain in pediatric oncology patients.
Methodology
This study included 90 patients under 18 years of age who underwent pain management in the algology clinic between 2002 and 2020. From the algology follow-up records, the following data were recorded: demographic information, follow-up time, cancer diagnosis and stage, cause and location of pain, systems involved, duration and intensity of pain, analgesic and adjuvant drugs prescribed, routes and duration of drug administration, complications, interventional procedures if performed, “pain intensity” scores prior to and following treatment, and daily and total analgesic consumption of the patients.
Results
The mean age was 11.4±4.1 years (min-max: 2-17). Leukemia and lymphoma were the most frequently diagnosed (30%). Of the 31 features identified in the staging, 27 (87.1%) were stage 4 at admission. The causes of pain in children were neoplasms in 81.2% (n = 73). At admission, 72.3% (n = 65) had severe pain for at least a month. It was determined that 90% (n = 81) of the patients were using opioids and 28.9% (n = 26) were using dual opioids. The mean tramadol dose was 129.0±97.9 mg/day (12-380 mg/day), and the mean morphine dose was 14.8±11.3 mg/day (1-52 mg/day). The mean transdermal fentanyl dose was 33.2±21.6 µgr/h (12-75 µgr/h). Adjuvant therapy was administered in 25.6% (n = 24) of the patients. Epidural catheterization was performed on 6.6% (n = 6) of the patients. The mean initial pain scores were 5.2±1.7, which decreased to 1.5±0.7 with a significant difference (p < 0.001). In the study, 93% (n = 84) of the patients had no pain management complications noted.
Conclusions
The pain level that pediatric cancer patients endure critically influences their and their family’s quality of life. The fact that opioid-related adverse effects associated with pediatric pain management occur far less frequently than previously thought may help prevent opiophobia. Effective and safe analgesia can be provided with multimodal analgesia to manage pediatric cancer pain.
