Abstract
Whilst not strictly a neuropathic injury, cancer-induced bone pain (CIBP) is a unique
state with features of neuropathy and inflammation. Recent work has demonstrated that
osteoclasts damage peripheral nerves (peptidergic C fibres and SNS) within trabeculated
bone leading to deafferentation. In addition, glia cell activation and neuronal hyperexcitability
within the dorsal horn, are all similar to a neuropathy. Gabapentin and carbamazepine
(both anti-convulsants that modulate neuropathy) are effective at attenuating dorsal
horn neuronal excitability and normalizing pain-like behaviours in a rat model of
CIBP. However alterations in neuroreceptors in the dorsal horn do not mimic neuropathy,
rather only dynorphin is upregulated, glia cells are active and hypertrophic and c-fos
expression is increased post-noxious behavioural stimulus. CIBP perhaps illustrates
best the complexity of cancer pains. Rarely are they purely neuropathic, inflammatory,
ischaemic or visceral but rather a combination. Management is multimodal with radiotherapy,
analgesics (opioids, NSAIDs), bisphosphonates, radioisotopes and tumouricidal therapies.
The difficulty with opioids relates to efficacy on spontaneous pain at rest and movement-related
pain. Potential adjuvants to standard analgesic therapies for CIBP are being explored
in clinical trials and include inhibitors of glutamate release.
Keywords
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Article info
Publication history
Published online: April 28, 2008
Accepted:
March 6,
2008
Received:
March 6,
2008
Identification
Copyright
© 2008 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
