Anatomy, physiology, and neuropharmacology of cancer pain Journal Article


Author: Payne, R.
Article Title: Anatomy, physiology, and neuropharmacology of cancer pain
Abstract: The anatomy, physiology, and pharmacology of nociception and its modification by analgesic drugs have been studied extensively in the past decade. Although the neural mechanisms of nociceptors and the stimuli that activate them are much better understood, it must be emphasized that the perception of pain, as well as the meaning of pain to the individual, is a complex behavioral phenomenon and involves psychologic and emotional processes in addition to activation of nociceptive pathways. Pain related to malignant disease can be classified as somatic, visceral, and deafferentation in type. Somatic pain and visceral pain direct activation of nociceptors and are often a complication of tumor infiltration of tissues or injury of tissues as a consequence of cancer therapy. The management of this type of pain is typically accomplished by treating the tumor (with surgery, chemotherapy, and/or radiation therapy) and by using the appropriate non-narcotic, narcotic, and adjuvant analgesic agents. Neuroablative therapies may be helpful in specific circumstances. For example, cordotomy may be helpful for unilateral pain below the waist in patients with somatic and visceral pain. This procedure may also be helpful for early deafferentation pain (i.e., lumbosacral plexopathy) in which peripheral nerves are compressed but not infiltered or destroyed by metastatic tumor growth. Deafferentation pain may be a complication of tumor infiltration or of peripheral nerve of cancer therapy that injures neural tissues. This type of pain is often poorly tolerated and difficult to control, particularly if not treated early and aggressively. Although incompletely understood, the pathophysiology of deafferentation pain appears to be different from that of somatic or visceral pain, and the treatment approaches may be different. Management approaches to deafferentation pain usually emphasize treatment of the pain, because injury to the nervous system may be difficult to reverse, even if one can successfully treat the underlying malignancy, and many deafferentation pain syndromes occur as a complication of cancer therapy. The role of narcotic analgesics in the management of deafferentation pain is not clear, although the published experience suggests that they are less useful than in somatic or visceral pain.
Keywords: review; cancer pain; central nervous system; morphine; drug therapy; therapy; nociception; peripheral nervous system; naloxone; oral drug administration; etiology; clonidine; amitriptyline; phenoxybenzamine; cordotomy; visceral pain; pain treatment; human; priority journal; intrathecal drug administration; neuropharmacology; enkephalin[2 alanine 5 leucine]
Journal Title: Medical Clinics of North America
Volume: 71
Issue: 2
ISSN: 0025-7125
Publisher: W.B. Saunders Co.  
Date Published: 1987-03-01
Start Page: 153
End Page: 167
Language: English
DOI: 10.1016/s0025-7125(16)30863-x
PUBMED: 3546978
PROVIDER: scopus
DOI/URL:
Notes: Article -- Export Date: 5 February 2021 -- Source: Scopus
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  1. Richard Payne
    68 Payne