Special Review Series: Experimental Advances in Understanding Cancer Pain

In this final contribution to the Special Review Series on basic mechanisms of cancer pain, Rosemary Polomano and I review recent progress in developing animal models of chemotherapy-evoked painful peripheral neuropathy. We now have treatment strategies and drugs to control most of the side effects of chemotherapy: nausea, anemia, and fatigue can be effectively managed in most cases. But several of the most effective antitumor agents injure peripheral nerves, and in a subset of patients they produce a painful peripheral neuropathy. We have no drugs to control or prevent the neurotoxicity. Pain and loss of nerve function are major dose-limiting effects for two of the most useful drugs, vincristine and paclitaxel. Unfortunately, the improved tumor killing obtained with combination chemotherapy increases the risk of neurotoxicity. The reasons for chemotherapy-evoked neurotoxicity and neuropathic pain are not known. Basic research in this area promises to have a direct impact on the efficacy of chemotherapy and on improving the quality of life for the cancer patient.