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American Pain Society
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GLENVIEW, IL, November 15, 2009 — Breast cancer patients treated with the chemotherapy drug Taxol (paclitaxel) are more likely to develop chronic neuropathic pain, according to research published in The Journal of Pain, the peer review publication of the American Pain Society.
Researchers from the University of Texas MD Anderson Cancer Center conducted a survey of breast cancer patients who participated in clinical trials of Taxol from 1994 to 2001. There were 240 respondents. The purpose of the study was to determine the association between chemotherapy-induced peripheral neuropathy (CIPN) and neuropathic pain in breast cancer patients treated with Taxol. The authors noted that few studies have examined the extent to which breast cancer survivors who experience CIPN during chemotherapy go on to develop chronic neuropathic pain.
Though survival rates for breast cancer have increased significantly, chemotherapy agents that make survival possible can cause structural damage to peripheral nerves, causing chronic pain from the resulting dysfunction in the nervous system. Dose-limiting toxicity for many chemotherapeutic agents is peripheral neuropathy.
The study results showed that breast-cancer patients who had experienced CIPN during their treatment with Taxol were three times more likely to eventually be diagnosed with chronic neuropathic pain. Taxol-treated patients, therefore, should be regularly monitored for neuropathic pain beyond treatment. The authors pointed out that the same cellular mechanism altered by Taxol to kill tumors can be toxic to normal tissue. They explained further that patients at MD Anderson given weekly doses of Taxol are monitored closely for symptoms of worsening CIPN. In some cases, physicians and patients should review the risks and benefits for continuing Taxol if worsening neuropathy is likely.
Source: Chemotherapy-induced Peripheral Neuropathy as a Predictor of Neuropathic Pain in Breast Cancer Patients Previously Treated with Paclitaxel, Cielito C. Reyes-Gibby, Phuong Khang Morrow, Aman Buzdar and Sanjay Shete, University of Texas MD Anderson Cancer Center
Fibromyalgia syndrome (FMS) is well known for having myriad symptoms, especially musculoskeletal pain and widespread tenderness. The disease also has a significant psychological burden, such as greater risk for depression and anxiety. Researchers at the University of Tulsa sought to assess the role played by defensive sensory activation and appetitive activation in promoting or inhibiting pain. They evaluated 17 FMS patients and 17 control subjects using tests in which subjects viewed pleasant and unpleasant photos to measure appetitive and defensive responding.
The authors explained that previous research has shown that defensive activation triggers pain/nociception while appetitive activation plays an inhibiting role. Therefore, pain can be enhanced in those with a greater propensity for defensive activation.
The study results showed that, compared with the control group, FMS patients demonstrated increased defensive activation in response to seeing unpleasant pictures, indicating that persons with FMS may attend more readily to aversive cues that signal a possible threat. The authors concluded that their research offers preliminary evidence that FMS is associated with enhanced defensive activation but not with deficits in appetitive activation. Interventions for FMS patients, therefore, should focus on training to regulate their responses to threatening stimuli to reduce negative affect and improve pain.
Source: Emily J. Bartley, Jamie L. Rhudy and Amy E. Williams, Department of Psychology, University of Tulsa, Oklahoma.
