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. Cancer 1992; 70:178-184.

Pain may predict poor prognosis in patients with oral squamous cell carcinoma

“…The rich blood supply and large numbers of nerves in the head and neck may affect tumor growth and/or pain. 23,24 Peripheral nociceptive mechanisms consistent with mechanical allodynia and hypersensitivity have been reported responsible for producing pain in patients with oral cancer. 25 For example, metabolic products of arachidonic acid, such as prostaglandins, are produced by OSCC cells, which sensitize primary afferent nociceptors and produce hyperalgesia.…”

“…25 This type of pain is histologically associated with tumor infiltration and compression of peripheral nerves and nociceptive receptors. 24 Highly invasive tumors may directly stimulate peripheral nerve endings and nociceptive receptors. Since we previously reported that tumor size was not correlated with pain, 15 oral cancer pain likely does not result from the mass effect of the tumor.…”

Pain as sign of recurrent disease in head and neck squamous cell carcinoma

“…2,3,8,9 Because pain may be the first symptom of recurrent disease, we have retrospectively analyzed the importance of pain assessment and the diagnosis of tumor recurrence with special reference to referred pain.…”

Pain Control in Head and Neck Cancer

“…Neuropathic pain is pain associated with injury or disease of the peripheral or central nervous systems, which may result in pathophysiological changes such as ectopic (spontaneous or evoked) discharge by nerves, microneuroanatomical changes, central sensitization, and many others beyond the scope of this review (Macintyre & Schug, 2007). Neuropathic pain for patients with head and neck cancer may involve all sensory nerves in the face, skull, neck and shoulders (Vecht et al, 1992). Some common symptoms of neuropathic pain experienced by the patients include spontaneous continuous burning (81%), shooting pain (69%) and allodynia (88%) -which describes abnormal pain elicited by light touch (Sist et al, 1999;Merskey & Bogduk, 1994).…”