Neurophysiology of Cancer Pain

Regan, Joan; Peng, Philip

doi:10.1177/107327480000700201

Cited by 47 publications

(38 citation statements)

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“…61,70 NCP can arise as a consequence of cancer-directed therapy, such as surgery, radiotherapy and chemotherapy (treatment-related therapy). 7,[71][72][73][74][75] Treatment adverse effects include joint pain following chemotherapy and hormonal therapy and/or painful mucositis due to radiotherapy and chemotherapy with certain agents. It has been widely reported that drugs such as paclitaxel, vincristine, cisplatin and bortezomib may produce sensory neuropathies.…”

Section: 49mentioning

confidence: 99%

“…Some of the mechanisms contributing to CIBP include periosteum stretching by tumor expansion, bony distortion by local microfractures, nerve compression due to collapsed vertebrae or direct tumor encroachment, and algesic substances local release from the bone marrow. 23,72,81,82 CIBP perhaps best illustrates the complexity of malignancies, clinically demonstrating a hallmark of cancer pain, with presence of painless disease at some sites and severely painful at others. 7 Bone pain has been correlated with osteoclastic activity.…”

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confidence: 99%

“…Since cancellous bone provides a large surface area compared with the cortical one, it is not surprising that neoplastic disorders of bone remodeling are expressed earlier at cancellous sites. 23,61,72 NCP is characterized by spontaneous burning, with intermittent sharp, stabbing, or lancinating characteristics, hyperalgesia and allodynia. Relationship between mechanisms and symptomatology is complex.…”

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Pharmacological Treatment of Neuropathic Cancer Pain: A Comprehensive Review of the Current Literature

et al. 2011

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Neuropathic cancer pain (NCP), commonly encountered in clinical practice, may be cancer-related, namely resulting from nervous system tumor invasion, surgical nerve damage during tumor removal, radiation-induced nerve damage and chemotherapy-related neuropathy, or may be of benign origin, unrelated to cancer. A neuropathic component is evident in about 1/3 of cancer pain cases.Although from a pathophysiological perspective NCP may differ from chronic neuropathic pain (NP), such as noncancer-related pain, clinical practice, and limited publications have shown that these two pain entities may share some treatment modalities. For example, co-analgesics have been well integrated into cancer pain-management strategies and are often used as First-Line options for the treatment of NCP. These drugs, including antidepressants and anticonvulsants, are recommended by evidence-based guidelines, whereas, others such as lidocaine patch 5%, are supported by randomized, controlled, clinical data and are included in guidelines for restricted conditions treatment. The vast majority of these drugs have already been proven useful in the management of benign NP syndromes. Treatment decisions for patients with NP can be difficult. The intrinsic difficulties in performing randomized controlled trials in cancer pain have traditionally justified the acceptance of drugs already known to be effective in benign NP for the management of malignant NP, despite the lack of relevant high quality data. Interest in NCP mechanisms and pharmacotherapy has increased, resulting in significant mechanism-based treatment advances for the future. In this comprehensive review, we present the latest knowledge regarding NCP pharmacological management. n INTRODUCTIONFollowing EFIC's (European Federation of IASP Chapters) declaration in 2001, pain is not a symptom but a disease in its own right, necessitating appropriate treatment. The word pain usually refers to a discrete sensory experience, triggered by an identifiable set of ''painful'' stimuli, acting on a unique or stable ''pain'' pathway and eliciting an invariant sensation. However, pain, and particularly neuropathic pain (NP) can also exist as a diverse group of complex phenomena of unpleasant and distressing nature. NP encloses numerous complicated neurobiologic constituents and reflects potentially dynamic mechanisms, interacting at multiple neuraxial sites. 1Modern neurobiological techniques have led to tremendous progress in the exploration of pain pathogenetic mechanisms. [2][3][4] Research indicates that pain can be produced in multiple ways, at different locations, co-existing between and across various pathological conditions. 5,6 Novel therapeutic targets have been discovered and are used by the pharmaceutical industry for the construction of highly specific molecules, acting as potential innovative analgesics. Recent targets' application, specific to precise NP mechanisms, will very soon enable treatment to be focused at particular mechanisms, introducing a mechanism-based therap...

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Pharmacological Treatment of Neuropathic Cancer Pain: A Comprehensive Review of the Current Literature

et al. 2011

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“…Neuropathic cancer pain is caused by peripheral or central nervous system damage due to released inflammatory cytokines that sensitize neurons. [37] Carcinoma-induced pain is not related to tumor size and small carcinomas produce severe pain. [6] These observations suggest that carcinoma pain is primarily of neuropathic origin and is characterized by mechanical hyperalgesia.…”

Section: Introductionmentioning

confidence: 99%

Peripheral cannabinoids attenuate carcinoma-induced nociception in mice

Guerrero

Quang

Dekker³

et al. 2008

Neuroscience Letters

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We investigated the cannabinoid receptor (CBr) agonists Win55,212-2 (non-selective) and AM1241 (CBr2 selective) and the peripheral receptor (CBr1) in carcinoma-induced pain using a mouse model. Tumors were induced in the hind paw of female mice by local injection of a human oral squamous cell carcinoma (SCC). Significant pain, as indicated by reduction in withdrawal thresholds in response to mechanical stimulation, began at four days after SCC inoculation and lasted to 18 days. Local administration of Win55,212-2 (10 mg/kg) and AM1241 (10 mg/kg) significantly elevated withdrawal thresholds, indicating an antinociceptive effect. Ipsilateral expression of CBr1 protein in L5 DRG was significantly upregulated compared to ipsilateral L4 DRG and in normal tissue. These findings support the suggestion that cannabinoids are capable of producing antinociception in carcinoma-induced pain.

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“…Although this information holds promise for the development of new therapies for cancer pain, blocking these mediators individually is not sufficient to block cancer pain completely, indicating that tumor-induced pain is produced by multifaceted mechanisms. Several recent reviews 28,40,60,61,70,[101][102][103][104]114,137,145,169,170,183 focus on the mechanisms of cancer pain and the mediators involved, and the reader is referred to these excellent sources for more complete summaries of this information.…”

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Animal Models of Cancer Pain

Pacharinsak

Beitz²

2010

Animal Models of Pain

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220Pain is one of the most common and distressing symptoms experienced by both human and veterinary oncology patients with advanced cancer. In humans, unrelieved pain can disrupt and interfere with activities of daily living, quality of life, and mood, 26,173 and domestic animals typically are euthanized when pain is no longer adequately controlled. 138 New developments in cancer detection and therapy have occurred over the past decade. These developments are contributing to longer life expectancies and have raised important issues related to quality of life, as attention has focused increasingly on how to manage cancer pain effectively. 91,115,134 This increased attention is true in the fields of both human and veterinary medicine. Human cancer patients who are in advanced stages of the disease, particularly those with bone metastasis, report that they experience significant pain, and pain intensity appears to be related to the degree of bone destruction. Similarly, pain secondary to cancer in domestic animals is a key concern in veterinary practice and should be addressed promptly to alleviate suffering, stress, and anxiety and to improve quality of life. Not only do cancer patients have to deal with persistent pain, they also often experience 'breakthrough pain.' Breakthrough pain-intermittent episodes of extreme pain-occurs spontaneously or after movement or weight-bearing of the affected leg. 114,133 Canine osteosarcoma has many clinical and biological similarities to human osteosarcoma, and affected dogs show signs of both ongoing and breakthrough pain. 37 In addition to cancer-induced pain, human patients also experience pain caused by the very therapies used to treat the cancer. Almost 30% of adult cancer patients and 60% of pediatric cancer patients who have undergone treatments that include radiation, chemotherapy, or surgery also have experienced pain resulting from these therapeutic procedures. 49,174 Whether radiation treatment and chemotherapy also induce pain in domestic animals is virtually impossible to address, because carefully controlled studies have not examined this issue.Pain intensity varies among cancer patients and is dependent on a patient's pain sensitivity, the type of cancer, and the tumor location. 48,49 Cancer treatment guidelines provided by the World Health Organization have been used in oncology and pain treatment clinics. 20,25,92,113,117,119,163 Treatment of human cancer patients include the use of opioids, nonsteroidal antiinflammatory drugs (NSAIDs), corticosteroids, local anesthetics, antidepressants, and anticonvulsants either alone or in combination. Similarly in veterinary medicine, the goal of palliative therapy in cancer patients is to control pain from an incurable tumor and to support overall quality of life. 165 Therefore, opioids, NSAIDs, and bisphosphonates are used in addition to surgery and radiation therapy and are the drugs of choice in treating domestic animals with cancer pain, particularly those suffering from osteosarcoma and other forms of bone cancer. 1...

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Neurophysiology of Cancer Pain

Abstract: Understanding the neurophysiology of cancer pain promotes use of the most appropriate palliative measures for pain control.

Cited by 47 publications

References 60 publications

Pharmacological Treatment of Neuropathic Cancer Pain: A Comprehensive Review of the Current Literature

Pharmacological Treatment of Neuropathic Cancer Pain: A Comprehensive Review of the Current Literature

Peripheral cannabinoids attenuate carcinoma-induced nociception in mice

Animal Models of Cancer Pain

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