Clinical Manifestations of Neuropathic Pain and the Deleterious Effects of Chemotherapeutic Agents

Abstract: Neuropathic pain is a type of pain resulting from damage or dysfunction of the nervous system. Chemotherapy-induced peripheral neurotoxicity (CIPN) is a serious complication of cancer treatment, often occurring in a dose-dependent manner. CIPN is a sensory neuropathic syndrome characterized by motor and autonomic alterations of varying intensity and duration. The lack of effective treatment options for CIPN makes it a significant clinical challenge. A variety of chemotherapeutic agents can contribute to the development of CIPN, including vinca alkaloids, platinum-based antineoplastic agents, epothilones (ixabepilone), proteasome inhibitors (bortezomib), taxanes, and immunomodulatory drugs (thalidomide), along with the genetic factors. Single nucleotide polymorphisms (SNPs) in genes, such as CEP72 and EPHA, have been linked to increased susceptibility to CIPN. The treatment options for CIPN are limited and often require careful consideration due to potential side effects and patient comorbidities. Pharmacological interventions, such as anticonvulsants, gabapentin, and pregabalin, are commonly used to manage neuropathic pain. Tricyclic antidepressants like amitriptyline and nortriptyline can be effective, but their use may be limited due to side effects. In severe cases, opioids may be considered, but they should be used cautiously due to the risk of addiction and other adverse effects. The lidocaine or capsaicin creams and patches can provide localized pain relief. The non-pharmacological interventions like physical therapy can help improve strength, balance, and mobility. Transcutaneous electrical nerve stimulation and spinal cord stimulation are invasive procedures that may be considered for severe, intractable pain. Complementary therapies and cognitive-behavioural therapy can help patients cope with pain and improve their quality of life.