title: Pain in chemotherapy-induced neuropathy--more than neuropathic?
abstract: 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 ± 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: -1.46 ± 0.21, P < 0.01) was most impaired in RestP; mechanical hyperalgesia was exclusively found in MovP (z score: +0.81 ± 0.30, P < 0.05). "Anxiety" discriminated between painful and painless CIN; "CDT" and "anxiety" 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.
authors.affiliation: Klinik und Poliklinik für Neurologie, Universitätsmedizin der Johannes Gutenberg-Universität, Mainz, Germany Rehaklinik Nahetal, Bad Kreuznach, Germany Zentrum für Biomedizin und Medizintechnik (CBTM), Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany Murdoch University, Perth, Australia.
authors.forename: Christian
authors.initials: C
authors.lastname: Geber
authors.forename: Markus
authors.initials: M
authors.lastname: Breimhorst
authors.forename: Berenike
authors.initials: B
authors.lastname: Burbach
authors.forename: Christina
authors.initials: C
authors.lastname: Egenolf
authors.forename: Bernhard
authors.initials: B
authors.lastname: Baier
authors.forename: Marcel
authors.initials: M
authors.lastname: Fechir
authors.forename: Juergen
authors.initials: J
authors.lastname: Koerber
authors.forename: Rolf-Detlef
authors.initials: RD
authors.lastname: Treede
authors.forename: Thomas
authors.initials: T
authors.lastname: Vogt
authors.forename: Frank
authors.initials: F
authors.lastname: Birklein
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy* / Q000453:epidemiology; D009437:Neuralgia / Q000139:chemically induced* / Q000175:diagnosis* / Q000453:epidemiology; D010147:Pain Measurement / Q000379:methods*; D011795:Surveys and Questionnaires / Q000592:standards
chemical_list: D000970:Antineoplastic Agents
keywords: Chemotherapy; Mixed pain; Musculoskeletal pain; Neuropathic pain; Pain drawings; Polyneuropathy; Quantitative sensory testing