Lack of association between angiotensin converting enzyme inhibitors and angiotensin receptor blockers and pain improvement in patients with oral cancer

Abstract

Background: There is a growing body of literature implicating angiotensin II in the modulation of tumor associated inflammation and pain. However, the impact of angiotensin converting enzyme inhibitors (ACEis) and angiotensin II receptor blockers (ARBs) on this pathway has not yet been studied in oral cancers. Our objective is to investigate the role of ACEi and ARB pharmacotherapy on preoperative pain and inflammatory biomarkers, neutrophil to lymphocyte ratio (NLR) and monocyte to lymphocyte ratio (MLR), in patients with oral cancer. Methods: We performed a retrospective study on patients who underwent oral cancer surgery. Wilcoxon rank sum test or Kruskal-Wallis analysis were used to evaluate differences in demographic, tumor-related, and preoperative characteristics and among patients using ARBs, ACEis, and no treatment. Multivariable analysis was fitted to estimate the effects of important covariates on severe preoperative pain. Results: 162 patients with oral malignancies were included in the study. After adjusting for significant covariates, patients with perineural invasion were found to have higher levels of pain (p = 0.0278). Likewise, patients taking ARBs were found to have lower levels of perineural invasion (p = 0.035). Our analysis did not demonstrate a significant difference in pain levels when comparing ARBs or ACEis to the no treatment group (p= 0.250). Furthermore, ARB or ACEi use did not significantly alter preoperative NLR (p = 0.701) or MLR (p = 0.869). Conclusions: When compared to no treatment, ARBs and ACEis are not associated with significant analgesic effect or decreased inflammatory scores (NLR, MLR).

Fadu head and neck squamous cell carcinoma induces hyperexcitability of primary sensory neurons in an in vitro coculture model

“…Although perineural invasion (PNI) is one of the most important factors predicting severe pain in patients with head and neck squamous cell carcinoma (HNSCC), 17 the exact mechanisms of peripheral sensitization are still poorly understood. Understanding how interactions between cancer cells and the peripheral nervous system contribute to spontaneous pain could help provide treatment alternatives to lessen this burden.…”

“…12,13,46 However, a recent systematic review of the literature suggests that nonsteroidal antiinflammatory drugs (NSAIDs) may play a role in malignant pain treatment that highlights the role of inflammation in cancerrelated nociception. 38 Although perineural invasion (PNI) is one of the most important factors predicting severe pain in patients with head and neck squamous cell carcinoma (HNSCC), 17 the exact mechanisms of peripheral sensitization are still poorly understood. Understanding how interactions between cancer cells and the peripheral nervous system contribute to spontaneous pain could help provide treatment alternatives to lessen this burden.…”