Pain as a First Manifestation of Paraneoplastic Neuropathies: A Systematic Review and Meta-Analysis

Abstract

IntroductionParaneoplastic neurological syndromes (PNS) consist of a heterogeneous group of neurological disorders triggered by cancer. The aim of this systematic review is to estimate the reported prevalence of pain in patients with paraneoplastic peripheral neuropathy (PPN).MethodsA systematic computer-based literature search was conducted on PubMed database.ResultsOur search strategy resulted in the identification of 126 articles. After the eligibility assessment, 45 papers met the inclusion criteria. Full clinical and neurophysiological data were further extracted and involved 92 patients with PPN (54.5% males, mean age 60.0 ± 12.2 years). The commonest first manifestation of PPN is sensory loss (67.4%), followed by pain (41.3%), weakness (22.8%), and sensory ataxia (20.7%). In 13.0% of the cases, pain was the sole first manifestation of the PPN. During the course of the PPN, 57.6% of the patients may experience pain secondary to the neuropathy.ConclusionsPain is very prevalent within PPN. Pain specialists should be aware of this. Detailed history-taking, full clinical examination, and requesting nerve conduction studies might lead to an earlier diagnosis of an underlying malignancy.

The Novel C5aR Antagonist DF3016A Protects Neurons Against Ischemic Neuroinflammatory Injury

“…It is characterized by cellular and molecular changes within the brain that involve many immunological mediators such as the complement system (Van Beek et al 2003 ). Neuroinflammation and the subsequent neurodegenerative processes have clear clinical consequences (Paladini et al 2015 ; Paladini et al 2016 ; Fusco et al 2017 ; Zis et al 2017 ; Zis et al 2017a ; Varrassi et al 2018 ) Uncontrolled complement activation can lead to excess tissue inflammation and damage; moreover, neuroinflammation induces sensitization and synaptic hyperactivity in the peripheral and central nervous system (Varrassi et al 2015 ).…”

“…They may be consequent to the activation of complement in the central nervous system (CNS) (Van Beek et al 2003 ). More recently, the importance of neurodegenerative processes has been related to concomitant pathological conditions connected to pain such as paraneoplastic neuropathies, rheumatic, and joint diseases (Fusco et al 2017 ; Zis et al 2017 ; Zis et al 2017a ). Despite being immunologically separate from the circulating plasma, and in the absence of blood-brain barrier (BBB) damage, cells of the CNS express many components of immunity including all complement (C) factors (Woodruff et al 2010 ; O'Barr et al 2001 ).…”

Chronic idiopathic axonal polyneuropathy: Prevalence of pain and impact on quality of life

“…The reported prevalence of pain in patients with diabetic PN, confirmed with NCS, is estimated to be 40%–50% (Ware, ). Previous systematic reviews have established that the prevalence of pain in paraneoplastic neuropathies is 58% (Didangelos, Doupis, & Veves, ) and in platin‐induced neuropathies is 46%, when referring to patients with established PN following chemotherapy completion (Zis, Paladini, et al, ). These figures are very similar to our findings, as in our cohort of CIAP patients, the estimated prevalence of peripheral neuropathic pain was 60%.…”

Neuropathic Pain in Acute and Subacute Neuropathies: A Systematic Review

“…Pain is very prevalent in paraneoplastic sensory ganglionopathies as it can affect up to 60% of patients during the course of the PNS. Pain is among the first symptoms of the paraneoplastic neuropathy in more than 40% of the patients and it can be the sole first manifestation of the paraneoplastic neuropathy in 13% of the patients (86,87).…”