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Cancer pain physiology
Sarah Falk1, Kirsty Bannister2, Anthony H Dickenson2
1Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
British Journal of Pain
|October 31, 2015
Summary
Animal models reveal cancer pain involves unique sensory processing changes, including bone destruction and nerve hypersensitivity. Understanding these mechanisms is key to developing better cancer pain treatments.
Area of Science:
- Neuroscience
- Oncology
- Pain Research
Background:
- Cancer pain mechanisms, unlike inflammatory and neuropathic pain, have been less understood due to limitations in early animal models.
- A specific murine model of cancer-induced bone pain, developed in 1999, has enabled detailed investigation into the condition.
Purpose of the Study:
- To elucidate the unique neuronal and pharmacological alterations in cancer-induced bone pain.
- To understand the sensory processing changes contributing to cancer pain.
- To discuss current and potential treatments based on mechanistic insights.
Main Methods:
- Utilized a murine model of cancer-induced bone pain confined to the femur.
- Investigated peripheral and central nervous system changes, including inflammation, neurochemical alterations, and spinal cord reorganization.
- Examined nocifensive behaviors indicative of hyperalgesia.
Main Results:
- Cancer-induced bone pain involves progressive bone destruction, increased osteoclast activity, and distinct hyperalgesia (ongoing, spontaneous, movement-induced).
- Cancer cells trigger inflammatory infiltrates and release factors causing peripheral nerve changes (e.g., reduced pH, direct afferent deformation).
- Peripheral changes lead to hypersensitive spinal cord neurons and altered brain pathways involved in pain's emotional component.
Conclusions:
- Cancer pain exhibits unique sensory processing alterations beyond inflammatory and neuropathic components.
- Understanding these mechanisms, including spinal cord reorganization and neurotransmitter changes, is crucial for managing the affective aspects of cancer pain.
- Opioid therapy for cancer pain may be complicated by opioid-induced hyperalgesia, necessitating further research into its mechanisms and treatment.
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