Treatment of neuropathic pain in cancer patients

Abstract

The prevalence of neuropathic pain in cancer patients is high, up to 40% of cancer patients with pain. It seems that the percentage of patients with neuropathic pain component may be higher because of co-existence of nervous system changes in patients with bone pain and more common use of potentially neurotoxic methods of cancer treatment: radiotherapy, chemotherapy and more commonly new introduced molecular therapies of cancer. The diagnosis of neuropathic pain can be established by a detailed history taking including clinical symptoms, physical examination, investigations and additionally the use of validated instruments designed for neuropathic pain assessment. The treatment of neuropathic pain in cancer patients is based mainly on pharmacotherapy with opioids recommended as first-line agents for the treatment of neuropathic cancer pain. Adjuvant analgesisc especially antidepressants and anticonvulsants are often effective in combination with opioids, however apart from analgesia improvement they may enhance the risk of adverse events. A significant role play oncology treatment, especially palliative radiotherapy and systemic treatment and in selected patients’ interventional techniques may be carefully considered. Therapy of neuropathic pain should be an important element of a wider holistic plan of the treatment of cancer patients, which takes into account a meticulous assessment of pain and other symptoms, evaluation of patients and careers needs with the aim of a complex therapeutic approach as an effective treatment of symptoms, psychosocial and spiritual support, which may significantly improve patients and careesrs quality of life.