Chapter 16 - The management of neuropathic pain in cancer patients

Summary

Neuropathic pain is present in approximately 20-30% of cancer patients with pain. The pathological mechanisms responsible for neuropathic pain are multifactorial. Assessment of neuropathic pain is crucial to appropriate management. Several pain scales were developed for patients with cancer pain. A meticulous neurology examination is helpful to evaluate thoroughly cancer patients with neuropathic pain. The pharmacological management of neuropathic cancer pain has recently been reviewed. Tramadol, codeine, and dihydrocodeine are recommended for the treatment of mild-to-moderate cancer pain intensity. The use of an analgesic ladder should be individualized with appropriate application of supportive drugs (e.g. laxatives and antiemetics) for the prevention and treatment of opioid adverse effects. Non-pharmacological measures, such as radiotherapy and invasive procedures (nerve blockades and neurolytic blocks) should also be used as required. In patients with very severe neuropathic pain, a combination of opioids and N-methyl-D-aspartate (NMDA) receptor antagonists (e.g. ketamine) are recommended.