Objective evaluation of chemotherapy-induced peripheral neuropathy using quantitative pain measurement system (Pain Vision®), a pilot study

Abstract

BackgroundIn an evaluation of chemotherapy-induced peripheral neuropathy (CIPN), objectivity may be poor because the evaluation is determined by the patient’s subjective assessment. In such cases, management of neuropathy may be delayed and CIPN symptoms may become severe. In this pilot study, we attempted an objective evaluation of CIPN using a quantitative pain measurement system (Pain Vision®).MethodsThe subjects were patients with gynecologic cancer who underwent chemotherapy using taxane and platinum drugs. The grade of the peripheral sensory nerve disorder was based on the Common Terminology Criteria for Adverse Events (CTC-AE) ver. 4.0 and was evaluated before the initiation of therapy and up to six chemotherapy cycles. A symptom scale assessed by the patients using a peripheral neuropathy questionnaire (PNQ) was also evaluated. Simultaneously during these evaluations, graded electric current was applied from the probe to a fingertip and measured both the lowest perceptible current and lowest current perceived as pain by Pain Vision®. From these values, the pain degree was calculated from the following formula: (pain perception current value - lowest perceptible current value) ÷ lowest perceptible current value × 100. We compared the pain degrees by Pain Vision® during CIPN development with the value obtained before chemotherapy initiation.ResultsForty-one patients were enrolled. In the evaluation by a medical professional, 28 (64.3%) patients developed CIPN during 2.5 ± 1.1 chemotherapy cycles (mean ± standard deviation). The pain degree by Pain Vision® at grade 1 and 2 CIPN development according to the evaluation (CTC-AE) was significantly decreased compared to that before chemotherapy initiation (126.0 ± 114.5 vs. 69.8 ± 46.8, p = 0.001, and 126.0 ± 114.5 vs. 32.8 ± 32.6, p = 0.004). Changes in the pain degree by Pain Vision® were also found during scale B and C, D CIPN development in the patient evaluation (PNQ) (115.9 ± 112.4 vs. 70.6 ± 56.5, p = 0.005, and 115.9 ± 112.4 vs. 46.3 ± 42.9, p = 0.004). In the 13 patients in whom CIPN did not occur, no significant decrease in the pain degree by Pain Vision® was detected (p = 0.764). There was no discontinuation of the measurements because of adverse events such as discomfort from the electric current.ConclusionThe decrease in the pain degree measured by Pain Vision® was associated with the onset of CIPN symptoms. Particularly, detection of CIPN by Pain Vision® was possible, though most of the CIPN that occurred was low grade or mild symptom. Pain Vision® might become a noninvasive and convenient objective CIPN detection tool to supplement subjective CIPN evaluation.Trial registrationThe study approval number in the institution; H25–140. Registered December 17, 2013.

The Relationship Between Evaluation Methods for Chemotherapy-Induced Peripheral Neuropathy

“…Although an evaluation method that can quantify CIPN enables interindividual and intraindividual comparison, Sato et al . reported that there was no significant difference between PV and CTCAE grades in the evaluation of CIPN 42 . If the severity of CIPN and PV do not correlate, PV cannot be used to evaluate clinical trials aimed at improving CIPN.…”

New Method for the Quantitative Assessment of Sensory Disturbances in Cervical Myelopathy: Application for Neurological Level Diagnosis

“…Furthermore, the device could be used to compare disease severity among patients and to assess individual patient neurological conditions before and after treatment, which may not be possible with conventional sensory tests. PainVision ® has been previously employed in clinical practice to evaluate peripheral neuropathy, low back pain, and postherpetic neuralgia 15,18,25) ; however, it has not been used to measure sensory deficits in patients with cervical myelopathy. Our results reveal that PainVision ® can provide objective, quantitative data that are useful for determining neurological levels, as evidenced by the good correlation of CPT measurements with the functional status and the level of cervical cord compression revealed by MRI.…”

A simple method of quantifying chemotherapy‐induced peripheral neuropathy using PainVision PS‐2100®

“…Because CIPN manifests at the tip of the limbs, some may wonder whether PV measurement may be performed on the ulnar side of the forearms or at the tip of the limbs. Sato et al evaluated data from finger tips obtained from 41 patients, of which 28 manifested CIPN, and concluded that CIPN may be objectively evaluated by lowering the pain threshold using noninvasive and easy‐to‐use PV. Our present data show that further consideration is necessary at this point with regard to CIPN evaluation through the use of PV at the finger tips.…”