Types and causes of pain in cancer of the head and neck

Abstract

In a series of 25 patients with head dnd neck cancer who had severe pain, the type and cause of the pain were analyzed. There were two types of pain: nociceptive and nonnociceptive. Nineteen (76%) patients had nociceptive pain that could be subdivided into actual nociceptive pain (9 patients), nociceptive nerve pain (8 patients), or referred pain (2 patients). The cause of nociceptive pain was secondary to tumor recurrence in 16 patients and secondary to benign inflammation in 3 patients. Of the six (23%) cases of non‐nociceptive pain, all were diagnosed as neuropathic pain secondary to the sequels of neck dissection. World Health Organization guidelines were applied for the treatment of symptomatic pain of nociceptive pain; if necessary, nerve blocks were used after this treatment. Non‐nociceptive pain was usually treated with amitriptyline or carbamazepine. If tumor recurrence was the cause of the pain, antitumor‐directed therapy was applied, when possible. Relief was achieved in 52% of the patients after two attempts to treat pain, in 64% after three attempts, and in up to 72% after four attempts. Pain could not be controlled in 28% of the patients. Patients with tumor recurrence had a short median survival time of 3 months, regardless of pain control. Patients with neuropathic pain had a survival time of 16 months or more (median not reached). The authors conclude that the type and cause of the pain in cancer of the head and neck can be determined; this can lead to the administration of proper symptomatic therapy or treatment directed at the underlying cause. In most cases, several successive attempts to treat pain were made before relief was achieved.

Pain is associated with an endophytic cancer growth pattern in patients with oral squamous cell carcinoma before treatment

“…This type of pain is histologically related to infi ltration of the peripheral nerves and nociceptive receptors by the cancer. 15 Cancer with a high grade in the histological mode of invasion such as YK-4 may directly stimulate the peripheral nerve endings and nociceptive receptors. Oral cancer pain may result from the dense distribution of trigeminal nerve invasion of the oral cavity.…”

“…3,5,15,18 Epstein and Stewart 5 reported that pain was present at the time of diagnosis in 82% of 31 patients with head, neck, or oropharyngeal cancer. Cuffari et al 3 reported that about 67% of patients awaiting treatment for oral cancer complain of pain.…”

Difficult problems and their solutions in patients with cancer pain of the head and neck areas

“…Severe, progressive posttreatment pain associated with occult recurrent tumors is not uncommon. Recurrence pain is typically located near the tumor site and continuous in temporal pattern [15]. In addition, a neuropathic "shooting" quality is frequently reported by patients with tumor recurrence pain [19•].…”

Regional pain syndromes in cancer patients

“…The most common causes of this syndrome are the "extracranial" etiologies, with maxillary sinus, pharyngeal, laryngeal, and oral cavity tumors being the most frequent diagnoses [16]. Despite cancer being an uncommon cause of cranial nerve palsies, this scenario is not uncommon in patients with head and neck cancer.…”

“…Despite cancer being an uncommon cause of cranial nerve palsies, this scenario is not uncommon in patients with head and neck cancer. Headache, neuropathic facial pain characteristic of the nerve distribution, and neurologic deficits are the most common manifestations of these syndromes [16,17].…”