Basic science and clinical management of painful and non-painful chemotherapy-related neuropathy

Kim, Joyce H.; Dougherty, Patrick M.; Abdi, Salahadin

doi:10.1016/j.ygyno.2015.01.524

Cited by 77 publications

(60 citation statements)

References 90 publications

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“…Clinical classification of pain in cancer survivors is of importance as it has clear therapeutic implications in terms of pharmacological and non-pharmacological management [19,20,44]. For example, pain education is an effective but underused strategy for treating cancer pain [45].…”

Section: Discussionmentioning

confidence: 99%

Pain following cancer treatment: Guidelines for the clinical classification of predominant neuropathic, nociceptive and central sensitization pain

et al. 2016

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Background: In addition to fatigue, pain is the most frequent persistent symptom in cancer survivors. Clear guidelines for both the diagnosis and treatment of pain in cancer survivors are lacking. Classification of pain is important as it may facilitate more specific targeting of treatment. In this paper we present an overview of nociceptive, neuropathic and central sensitization pain following cancer treatment, as well as the rationale, criteria and process for stratifying pain classification. Material and methods: Recently, a clinical method for classifying any pain as either predominant central sensitization pain, neuropathic or nociceptive pain was developed, based on a large body of research evidence and international expert opinion. We, a team of 15 authors from 13 different centers, four countries and two continents have applied this classification algorithm to the cancer survivor population. Results: The classification of pain following cancer treatment entails two steps: (1) examining the presence of neuropathic pain; and (2) using an algorithm for differentiating predominant nociceptive and central sensitization pain.Step 1 builds on the established criteria for neuropathic pain diagnosis, whileStep 2 applies a recently developed clinical method for classifying any pain as either predominant central sensitization pain, neuropathic or nociceptive pain to the cancer survivor population. Conclusion: The classification criteria allow identifying central sensitization pain following cancer treatment. The recognition of central sensitization pain in practice is an important development in the integration of pain neuroscience into the clinic, and one that is relevant for people undergoing and following cancer treatment.

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Section: Discussionmentioning

confidence: 99%

Pain following cancer treatment: Guidelines for the clinical classification of predominant neuropathic, nociceptive and central sensitization pain

et al. 2016

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“…It is estimated that up to 90% of all cancer patients receiving chemotherapy will be affected by CIPN at various severity levels (Bokhari and Sawatzky, 2009). Pain intensity in patients experiencing CIPN is distressing and debilitating and could lead to treatment discontinuation with obvious consequences on clinical outcome (Kim et al, 2015). Due to the lack of specific therapies, CIPN is treated with the same therapeutic approaches employed in other chronic pain states.…”

Section: Clinical Aspects Of Cipnmentioning

confidence: 99%

“…First-line treatments include voltagegated calcium channel alpha-2-delta blockers, tricyclic antidepressants, selective serotonin and norepinephrine reuptake inhibitors and local anesthetics. Opioid analgesics represent secondline therapies, while third-line therapies include other antidepressant medications, membrane stabilizers, NMDA receptor antagonists, and topical agents (Kim et al, 2015). These classes of drugs often have severe side effects when used chronically.…”

Section: Clinical Aspects Of Cipnmentioning

confidence: 99%

Selective HCN1 block as a strategy to control oxaliplatin-induced neuropathy

et al. 2018

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a b s t r a c tChemotherapy-Induced Peripheral Neuropathy (CIPN) is the most frequent adverse effect of pharmacological cancer treatments. The occurrence of neuropathy prevents the administration of fully-effective drug regimen, affects negatively the quality of life of patients, and may lead to therapy discontinuation. CIPN is currently treated with anticonvulsants, antidepressants, opioids and non-opioid analgesics, all of which are flawed by insufficient anti-hyperalgesic efficacy or addictive potential. Understandably, developing new drugs targeting CIPN-specific pathogenic mechanisms would dramatically improve efficacy and tolerability of anti-neuropathic therapies. Neuropathies are associated to aberrant excitability of DRG neurons due to the alteration in the expression or function of a variety of ion channels. In this regard, Hyperpolarization-activated Cyclic Nucleotide-gated (HCN) channels are overexpressed in inflammatory and neuropathic pain states, and HCN blockers have been shown to reduce neuronal excitability and to ameliorate painful states in animal models. However, HCN channels are critical in cardiac action potential, and HCN blockers used so far in pre-clinical models do not discriminate between cardiac and non-cardiac HCN isoforms. In this work, we show an HCN current gain of function in DRG neurons from oxaliplatin-treated rats. Biochemically, we observed a downregulation of HCN2 expression and an upregulation of the HCN regulatory beta-subunit MirP1. Finally, we report the efficacy of the selective HCN1 inhibitor MEL57A in reducing hyperalgesia and allodynia in oxaliplatin-treated rats without cardiac effects. In conclusion, this study strengthens the evidence for a disease-specific role of HCN1 in CIPN, and proposes HCN1-selective inhibitors as new-generation pain medications with the desired efficacy and safety profile.

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“…One of the barriers in pain treatment is the inadequate measurement and assessment of pain. An optimal management includes the evaluation of intensity, characteristics and interference with daily habits and life style [7,8].The measurement of QoL has become a central matter in clinical practice and research; also, it is very important in assessing treatment outcomes, as well as in determining whether a patient could receive certain treatment or not.One of the big challenges for oncologist/ researchers is to achieve treatments that are effective, noninvasive and with low toxicity. The antitumor effects of the standard chemotherapy regimens are dose related.…”

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confidence: 99%

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confidence: 99%

Quality of Life in Patients with Metastatic Breast Cancer Treated with Metronomic Chemotherapy

et al. 2016

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Aim:The objective of the study was to detect changes in quality of life (QoL) in metastatic breast cancer patients treated with metronomic chemotherapy with daily low doses of cyclophosphamide and celecoxib. Material & methods: Patients included in a Phase II trial, treated with metronomic cyclophosphamide and celecoxib were included in the QoL study. Assessment of QoL was carried out every 2 months by the Functional Assessment of Cancer Therapy Breast (FACT-B) questionnaire, Brief Pain Inventory and Eastern Cooperative Oncologic Group scale. Data were analyzed at three time points: baseline (BL); middle of treatment (MT); and end of treatment (ET). Results: A total of 20 patients were included. All patients were heavily pretreated. Treatment showed a good and safe therapeutic profile. With FACT-B questionnaire, no significant differences were observed during the response period (BL-MT). However, a significant increase was observed in the Emotional wellbeing and Additional concerns axes, when the last time point was included in the analysis (BL-MT-ET). A significant decrease in the proportion of patients with pain was found when comparing BL with ET (p = 0.046). The assessment with Eastern Cooperative Oncologic Group scale showed that 26.7% (4/15) of the patients improved their functional status and 40% (6/15) showed no changes, while 33.3% (5/10) worsened it. Conclusion: Patients treated metronomically for several months did not worsen their QoL. A high proportion of patients showed improvement or no changes and there were less patients with pain at the end of the treatment. The quality of life (QoL) is a very common term used in different fields of human health. Therefore, it is very difficult to find a unique definition since it could be related to all aspects of human life [1].In an attempt to define it, it can be said that it is "the perfect balance between well-being and distress" [2,3]. The concept of adaptation to chronic disease is different but it is related to that of QoL; adaptation is the process whereby individuals use conscious awareness and choice to create new human environmental integration [4,5]. Both are good indicators of the evolution of psychological features of cancer patients at different stages of the disease [6]. In oncology QoL is centered in patients' health, and refers to all aspects (general, social, personal, emotional, among others) of 1234RESEaRch aRticlE Perroud, Alasino, Rico et al. future science group the subject and their relationship to the cancer disease and its treatment.The presence of pain is a very complex aspect related to QoL, and it is one of the most difficult symptoms to evaluate and to treat; in many cases pain is caused by the pressure that the tumor exerts on bones and/or nerves, and also it could be caused by cancer treatment. One of the barriers in pain treatment is the inadequate measurement and assessment of pain. An optimal management includes the evaluation of intensity, characteristics and interference with daily habits and life style [7,8].The meas...

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Basic science and clinical management of painful and non-painful chemotherapy-related neuropathy

Cited by 77 publications

References 90 publications

Pain following cancer treatment: Guidelines for the clinical classification of predominant neuropathic, nociceptive and central sensitization pain

Pain following cancer treatment: Guidelines for the clinical classification of predominant neuropathic, nociceptive and central sensitization pain

Selective HCN1 block as a strategy to control oxaliplatin-induced neuropathy

Quality of Life in Patients with Metastatic Breast Cancer Treated with Metronomic Chemotherapy

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