Pain in chemotherapy-induced neuropathy - More than neuropathic?

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• 作者：Christian Geber ; Markus Breimhorst ; Berenike Burbach ; Christina Egenolf ; Bernhard Baier ; Marcel Fechir ; Juergen Koerber ; Rolf-Detlef Treede ; Thomas Vogt ; Frank Birklein
• 关键词：Chemotherapy ; Polyneuropathy ; Quantitative sensory testing ; Musculoskeletal pain ; Neuropathic pain ; Pain drawings ; Mixed pain
• 刊名：Pain
• 出版年：December, 2013
• 年：2013
• 卷：154
• 期：12
• 页码：2877-2887
• 全文大小：969 K

文摘

Chemotherapy-induced neuropathy (CIN) is an adverse effect of chemotherapy. Pain in CIN might comprise neuropathic and nonneuropathic (ie, musculoskeletal) pain components, which might be characterized by pain patterns, electrophysiology, and somatosensory profiling. Included were 146 patients (100 female, 46 male; aged 56 卤 0.8 years) with CIN arising from different chemotherapy regimens. Patients were characterized clinically through nerve conduction studies (NCS) and quantitative sensory testing (QST). Questionnaires for pain (McGill) and anxiety/depression (Hospital Anxiety and Depression Scale) were supplied. Patients were followed-up after 17 days. Large- (61%) and mixed- (35%) fibre neuropathies were more frequent than small-fibre neuropathy (1.4%). The 5 major chemotherapeutic regimens impacted differently on large- but not on small-fibre function and did not predict painfulness. Chronic pain associated with CIN was reported in 41.7%. Painless and painful CIN did not differ in QST profiles or electrophysiological findings, but different somatosensory patterns were found in CIN subgroups (pain at rest [RestP], n = 25; movement-associated pain [MovP], n = 15; both pain characteristics [MovP+RestP], n = 21; or no pain [NonP], n = 85): small-fibre function (cold-detection threshold, CDT: z score: 鈭?.46 卤 0.21, P < 0.01) was most impaired in RestP; mechanical hyperalgesia was exclusively found in MovP (z score: +0.81 卤 0.30, P < 0.05). 鈥淎nxiety鈥?discriminated between painful and painless CIN; 鈥淐DT鈥?and 鈥渁nxiety鈥?discriminated between patients with ongoing (RestP) and movement-associated pain (MovP) or pain components (MovP+RestP). The detrimental effect of chemotherapy on large fibres failed to differentiate painful from painless CIN. Patients stratified for musculoskeletal or neuropathic pain, however, differed in psychological and somatosensory parameters. This stratification might allow for the application of a more specific therapy.