Neuropathic cancer pain: prevalence, pathophysiology, and management

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.

Duloxetine and pregabalin in neuropathic pain of lung cancer patients

“…Mechanism of neuropathic pain in patients with cancer is similar with the other neuropathic pain groups, cancer‐related pain in the etiology of pain (bone invasion, nerve roots and plexus compression, infiltration of the tumor with nerve tissue, vascular infiltration, organ channel blockage, infiltration of fascia, periosteum, and other pain‐sensitive structures, infection and inflammation of the mucous membrane and other pain‐sensitive structures, pain due to the treatment (surgical treatment, chemotherapy, and radiotherapy), and noncancerous pain (trigeminal neuralgia, etc. ; Esin & Yalcin, ; Fallon, ; Pachman et al, ; Yoon & Oh, ).…”

“…Approximately 60% of cancer patients suffer from neuropathic pain (Pachman, Barton, Swetz, & Loprinzi, 2012). Esin & Yalcin, 2014;Fallon, 2013;Pachman et al, 2012;Yoon & Oh, 2018).…”

Managing pain in oncology

“…Neuropathic cancer pain is prevalent in as high as 40% of patients, and, apart from the direct invasion or nerve compression by the tumour, neuropathic cancer pain may also be caused due to various cancer treatments including radiotherapy, surgery and chemotherapy. There are various types of neuropathic cancer pain -knowing each type of pain improves diagnosis, treatment, and outcome (Yoon et al, 2018).…”

The role of pregabalin in neuropathic pain management in cancer patients

“…In 2006, the recommendations of the European Federation of Neurological Societies were published, which, in addition to the data concerning efficacy of medicines, include data on quality of life, the effect of treatment on sleep and the consequence of comorbidities. In subsequent years, numerous recommendations for treatment of neuropathic pain were published [1,14,15,31]. In 2007, recommendations for the neuropathic pain management in patients with chronic non-cancer-related pain were developed, which (with subsequent updates) include: I. Symptomatic treatment should be preceded by a diagnosis of the cause of neuropathic pain and, if possible, followed by appropriate causal treatment.…”