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Cancer and neuropathic pain

You are definitely familiar with symptoms as numbing, tingling, or prickling sensatiob,  after you have hit your funny bone, or your foot falls asleep. But for cancer patients, these sensations can be symptoms of either cancer itself, or, more often, a serious side effect of cancer therapy called neuropathy (injury to the nerves).

 Pain in cancer is caused by a great many variables, and part of the pain seems to originate due to injury to peripheral or central neurons. While our insight in central neuropathic pain is flimsy, we know more about neuropathic pain based on peripheral causes. The neural pathways, the pathogenesis of cancer pain via ion channels, receptors and neurotransmitters that are altered in cancer neuropathy are probably partly comparable to ‘normal’ neuropathic pain. However, the repeated injury due to the progression of the tumor and the so called paraneoplastic influences lead to special constellations of neuroreceptors and neurotransmitter- expression in patients suffering from cancer pain.  

Cancer pain, neuropathic cancer pain and treatment

There are some painkillers which do not make a lot of sense in treating cancer pain,k and we follow professor. dr. Tony Dickenson ufrom the UK who states that ibuprofen, aspirin, celecoxib, desipramin are all fairly useless.

On the other hand, the classical neuropathic painkillers might be useful in the treatment of cancer pain: venlafaxin, ethosuxamid, lidocain, pregabalin, lamotrigin, dextromethorphan, gabapentin, acetaminophen, carbamazepin, clonidin and morphine can be used. [1] Also modern opioids such as tapentadol from Gruenenthal might be a treating option. [1]

Cancer and chemotherapy induced neuropathy

Many drugs in chemotherapy are damaging to nerves, and cisplatin is the most well known. The neuropathy is worse, as patients are older or have been treated with high doses of cisplatin during longer periods of time. Apaet from cisplatin there are many other chemotherapeutic drugs which have neuropathy as a side effect.

Some supplements, electrical stimulation based on needles (electro-acupuncture) can be of use in treating the neuropathy and the painful neuropathy, and each patient has to find out whether these treatment options work for her or him. Extensive research is lacking. 

From the Centre for the study and treatment of neuropathic pain and neuropathy in Soest, the Nertherlands

This site helps patients and treating physicians, neurologists, anesthesiologists and other pain specialists to find the best and most up to date research findings related to neuropathy and neuropathic pain and the treatment thereof.

In our centre we are specialised in treating patients suffering from neuropathic pain and neuropathy following an Integrated Medicine concept. Part of our activities are within the field of consultation. We assist pharmaceutical companies in R&D strategies related to finding new drugs to treat neuropathic pain and neuropathy.

May 2010, Jan M. Keppel Hesselink, MD, PhD.

 

Referentie

[1] Wade WE, Spruill WJ. | Tapentadol hydrochloride: a centrally acting oral analgesic. | Clin Ther. | 2009 Dec;31(12):2804-18.