Functional interactions between tumor and peripheral nerve in a model of cancer pain in the mouse

Abstract

Cancer is usually accompanied by pain, which tends to increase in relation to metastatic infiltration and destruction. In the United States, 30% to 40% of newly diagnosed cancer patients and 67% to 90% of patients with advanced cancer report moderate to severe pain. Relief for approximately 90% of patients with cancer-related pain may be provided by the World Health Organization's "analgesic ladder," which involves progressing from non-opioid (e.g., acetaminophen, ibuprofen) to weak opioid (e.g., codeine), to strong opioid (e.g., morphine, fentanyl) intervention for pain relief. The severity of cancer pain is affected by diverse factors. In addition to the obvious factors of tumor size and degree of metastatic destruction, the type of tumor and its location are also important factors that contribute to pain severity. Severe cancer pain is especially associated with tumors involving bone destruction and nerve infiltration. Cancer pain seems to involve diverse mechanisms, including characteristics of both nociceptive and neuropathic pain. Unfortunately, even opioid analgesics often produce poor pain relief against neuropathic pain derived from peripheral nerve or root damage common to cancers involving bone metastases and nerve infiltration. In addition, these drugs may induce adverse side effects since they affect various physiological functions, including hormone secretion, neurotransmitter release, feeding, gastrointestinal motility, and respiratory activity. Currently, drug therapies utilizing antidepressants and anticonvulsants are being used to relieve neuropathic pain whereas cancer pain is treated largely with opiods in cancer patients.