Incidence and risk factors for developing chemotherapy-induced neuropathic pain in 500 cancer patients: A file-based observational study

J Peripher Nerv Syst. 2024 Mar;29(1):38-46. doi: 10.1111/jns.12616. Epub 2024 Feb 4.

Abstract

Objective: To define the incidence and risk factors for developing chemotherapy-induced neuropathic pain (CINP).

Methods: Retrospective, file-based analysis on cancer patients who received any type of conventional chemotherapy and for whom neurological evaluation was asked to reveal the extent of chemotherapy-induced peripheral neurotoxicity (CIPN) with or without CINP. CINP was assessed by means of the PI-NRS and Douleur Neuropathique-4 questionnaire. The total neuropathy score-clinical version graded the severity of CIPN.

Results: The medical files of 500 chemotherapy-treated cancer patients were reviewed. Any grade chronic CIPN was disclosed in 343 (68.6%) patients and CINP in 127 (37%) of them, corresponding to an overall percentage of 25.4% among all 500 included patients. The logistic regression analysis identified as independent predictors for CINP development the presence of uncomplicated diabetes (OR: 2.17; p = .039) and grade 2-3 chronic CIPN (OR: 1.61; p < .001) as also the administration of combined paclitaxel plus cisplatin (reference variable), compared to oxaliplatin (OR: 0.18; p = .001) and taxanes (OR: 0.16; p < .001). The increased severity of acute OXAIPN was associated with CINP (OR: 4.51; p < .001). OXA-treated patients with persistent CINP presented a worst likelihood to improve after chemotherapy discontinuation, than patients receiving combined paclitaxel plus cisplatin (OR: 50; p < .001).

Conclusion: The incidence of CINP in our cohort was comparable to previous reports, with severities fluctuating upwards during chemotherapy and declined post-chemotherapy. Uncomplicated diabetes, the combined paclitaxel plus cisplatin treatment and the increased severity of acute oxaliplatin neurotoxicity mostly increase the risk for developing CINP. OXA-treated patients present less possibilities to recover from CINP after chemotherapy discontinuation, than other chemotherapies.

Keywords: chemotherapy-induced neuropathic pain; chemotherapy-induced peripheral neurotoxicity; incidence; prediction; severity.

Publication types

  • Observational Study

MeSH terms

  • Antineoplastic Agents* / adverse effects
  • Cisplatin / adverse effects
  • Diabetes Mellitus*
  • Humans
  • Incidence
  • Neoplasms* / complications
  • Neoplasms* / drug therapy
  • Neuralgia* / chemically induced
  • Neuralgia* / epidemiology
  • Neurotoxicity Syndromes* / drug therapy
  • Neurotoxicity Syndromes* / epidemiology
  • Neurotoxicity Syndromes* / etiology
  • Oxaliplatin / adverse effects
  • Paclitaxel / adverse effects
  • Retrospective Studies
  • Risk Factors

Substances

  • Cisplatin
  • Oxaliplatin
  • Paclitaxel
  • Antineoplastic Agents