Painful polyneuropathy in patients with malignant neoplasms: generation, mechanisms of development, attempt of preventive therapy

Malignant neoplasms (MN) are a noninfectious pandemic disease of the 21st century. Despite the successful application of surgical, radiation methods and chemotherapy (CT), the quality of life of such patients often decreases significantly following the severe pain syndrome. The pain syndrome, leading to the development of paraneoplastic polyneuropathy (PNP) raises our particular interest. The purpose of this work was to study generation, mechanisms of development and targeted correction of painful PNP symptoms at various stages of CT, given a lack of consensus in the literature. 96 patients with oncological process of various localization and stage of MN were examined. The descriptors of the neuropathic pain syndrome in the limbs prior to the onset of CT were noted in 20 % of cases at algological screening. In the course of CT, its frequency increased to 82 % of cases during cycle #4 and up to 98 % during cуcles 6-7, accompanied by a statistically significant increase in the severity of pain assessed by DN4 and Pain Detect scales (p = 0.000), as well as significant deterioration in the quality of life of patients with the increase in reactive anxiety according to the Spielberger questionnaire (p = 0.000 and p = 0.042, respectively), without involving anxiety and depression according to the Beck questionnaire data (p = 0.684). Clinically the examined type of PNP along CT cycles came with depression of tendon reflexes, decrease in superficial sensitivity without significant involvement of motor functions and moderate autonomic disorders. The electroneurophysiological pattern of paraneoplastic PNP was initially defined as predominantly axonal sensory and, as the CT was performed, it was transformed into axonal sensory-motor. The attempt of preventive use of pregabalin in a number of patients allowed to objectify its effectiveness in management of the intensity and psychological aspects of neuropathic cancer pain during prolonged CT at significance value of p < 0.05.

paraneoplastic polyneuropathy, neuropathic pain syndrome, chemotherapy-induced polyneuropathy, pregabalin

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