Abstract
Pancreatic cancer is often diagnosed due to the patient seeking medical attention for abdominal pain. It is among the most painful cancers, with pain severity strongly correlating with prognosis. Perineural invasion is a prominent feature of pancreatic cancer and often the first route of metastasis resulting in neuropathic pain. While surgical pain is present, it is generally short-lived; chemo- and radio-therapy associated side effect pain is often longer lasting and more difficult to manage. Treatment-induced mucositis in response to chemotherapy occurs throughout the GI tract resulting in infection-prone ulcers on the lip, buccal mucosa, palate or tongue. Cisplatin treatment is associated with axonal neuropathy in the dorsal root ganglion, although other large sensory fibers can be affected. Opioid-induced hyperalgesia can also emerge in patients. Along with traditional means to address pain, neurolytic celiac plexus block of afferent nociceptive fibers has been reported to be effective in 74% of patients. Moreover, as cancer treatments become more effective and result in improved survival, treatment-related side effects become more prevalent. Here, pancreatic cancer and treatment associated pain are reviewed along with current treatment strategies. Potential future therapeutic strategies to target the pathophysiology underlying pancreatic cancer and pain induction are also presented.
Footnotes
↵* Both Authors contributed equally to this study.
Author's Contributions
IL and SPB both contributed to the writing of the manuscript.
This article is freely accessible online.
Conflicts of Interest
The Authors have no conflict of interest to report regarding this study.
Funding
SPB receives support from the National Institutes of Health (R01NS092671 and R01MH110441), the University of Miami Sylvester Comprehensive Cancer Center Molecular Therapeutics Shared Resource (MTSR), the Jay Weiss Institute for Health Equity and the Ryan Foundation.
- Received January 16, 2020.
- Revision received February 18, 2020.
- Accepted February 19, 2020.
- Copyright© 2020, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved