Iatrogenic painful neuropathic complications of surgery in cancer

• Published in: Acta anaesthesiologica Scandinavica 2001-10, Vol.45 (9), p.1090-1094
• Main Authors: Marchettini, P., Formaglio, F., Lacerenza, M.
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Humans; iatrogenesis; Iatrogenic Disease; Medical sciences; Multiple tumors. Solid tumors. Tumors in childhood (general aspects); Neoplasms - complications; Neoplasms - surgery; nerve injury; Neuralgia; neuropathic pain in cancer; Pain - etiology; Pain Management; Pain, Postoperative - pathology; Pain, Postoperative - therapy; Peripheral Nervous System Diseases - etiology; Peripheral Nervous System Diseases - therapy; Phantom Limb - pathology; post-chemotherapy neuralgia; post-radiotherapy neuralgia; postoperative neuralgia; Tumors
• ISSN: 0001-5172; 1399-6576
• DOI: 10.1034/j.1399-6576.2001.450907.x

It is estimated that at least one out of four patients with cancer complains of pain originating from nerve injury. Nerve injury may result from direct invasion/compression by tumour, or by remote effect of the cancer such as paraneoplastic polyneuropathy. In many cases, the nerve injury is caused by medical therapy, or surgical interventions. Pain generated by drugs or medical acts is called iatrogenic. A common iatrogenic neuralgia is chemotherapy induced painful polyneuropathy. This neuropathy typically affects mostly the small myelinated and unmyelinated nerve fibres. Surgical and anaesthesiological interventions also frequently cause direct nerve stretch or section. Some interventions, particularly those requiring extended resection, have a higher incidence of painful sequelae. Limb and colon amputation, nerve dissection, mastectomy and thoracotomy are the most common interventions for cancer known to cause nerve injury. As pain clinicians, we focus attention on the painful consequences of surgical interventions because there is evidence that a more accurate surgical approach and possibly a prophylactic prevention of the neuralgia may reduce the painful sequelae of nerve injury.