Diagnosing Neuropathic Pain in Patients with Cancer: Comparative Analysis of Recommendations in National Guidelines from European Countries

Abstract

This work demonstrates an important heterogeneity between European recommendations on diagnosis and assessment of neuropathic pain in patients with cancer. The main weaknesses are the low level of evidence and the absence of specific data focusing on neuropathic pain in patients with cancer. We recommend that physicians dealing with neuropathic pain in patients with cancer should be specially trained, that a specific methodology to develop CPGs should followed, and that specific research should be developed on the diagnosis of neuropathic pain in patients with cancer.

Cancer Pain With a Neuropathic Component: A Cross-sectional Study of Its Clinical Characteristics, Associated Psychological Distress, Treatments, and Predictors at Referral to a Cancer Pain Clinic

“…Achieving consensus and guideline consistency regarding precise diagnostic criteria for neuropathic pain, especially the ''definite'' category has been challenging and the process continues to evolve with ongoing clarifications. 27,28 Despite their shortcomings, 29 the use of screening tools has been advocated with the caveat that the ultimate diagnosis of an NPC is a clinical one, 30 especially in the cancer pain population, in which nociceptive and neuropathic components frequently co-exist. The DN4 screening sensitivity (74%) in our study was moderate, compared with 83% in the original DN4 validation study 24 and 87.5% in a crosssectional study in cancer patients.…”

Prospective study of neuropathic pain after definitive surgery for extremity osteosarcoma in a pediatric population

“…It is generally accepted that pain is frequently neuropathic in patients with cancer (19-39%), [3][4][5][6][7] either as cancer-related neuropathic pain (NP), cancer therapy-induced NP, or cancer-associated NP. Neuropathic pediatric cancer pain has been characterized [8][9][10][11] Pediatr Blood Cancer 2017; 64: e26162 c 2016 Wiley Periodicals, Inc. 1 of 6 wileyonlinelibrary.com/journal/pbc in four retrospective studies, one of them specifically investigating mixed nociceptive and NP after limb sparing surgery for bone cancer 9 ; nevertheless, no prospective studies of neuropathic pediatric cancer pain have been published so far.…”

Undertreatment of caner pain

“…Especially the neuropathic pain as related to surgical procedure or chemotherapeutic agents, previous study provided low level of evidence. 49 Some studies have explored the effect of physical therapy or exercise on the cancer pain; but the result remained inconsistency. 50e52 In considering its nature of chronic pain and its impact on emotional and psychosocial aspects of the life, future studies are needed to identify more effective treatment.…”