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7. Quantitative sensory testing in the German Research Network on Neuropathic Pain (DFNS): Somatosensory abnormalities in 1236 patients with different neuropathic pain syndromes

Author

Maier, C., Baron, R., Tölle, T.R., Binder, A., Birbaumer, N., Birklein, F., Gierthmühlen, J., Flor, H., Geber, C., Huge, V., Krumova, E.K., Landwehrmeyer, G.B., Magerl, W., Maihöfner, C., Richter, H., Rolke, R., Scherens, A., Schwarz, A., Sommer, C., Tronnier, V., Üçeyler, N., Valet, M., Wasner, G., and Treede, R.-D.

Published
2010
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17. Falls during oxaliplatin-based chemotherapy for gastrointestinal malignancies – (lessons learned from) a prospective study

Author

Galliardt Melanie, Betz Ulrich, Birklein Frank, Drees Philipp, and Geber Christian

Subjects
chemotherapy, fall-risk-index, outpatient setting, polyneuropathy, neurotoxicity, Medicine
Abstract

This prospective cohort study aimed to characterise the impact of oxaliplatin-based chemotherapy and its neurotoxic side effects (i.e., chemotherapy-induced neuropathy) on functional fall-risk and falls. Twenty chemotherapy-naïve participants (mean age, 59 years; 16 males) were consecutively included. A multimodal fall risk assessment was performed at four time points within 6 months. Polyneuropathy was assessed using the Neurologic Disability Scale; the fall risk was assessed by functional tests (Tinetti Test, Chair-Rising Test, and Timed up and Go Test). Patient-reported outcomes comprised the Hospitality Anxiety and Depression Scale (HADS), the Falls Efficacy Scale – International (FES-I) to assess the fear of falling, and the Physical Activity for the Elderly (PASE) questionnaire. Three falls occurred during the study. All fallen participants had a high fall risk-index (≥4 more risk factors) compared to only 30% of the non-fallen participants (p = 0.03) and suffered more frequently from pre-existing mild polyneuropathy (p = 0.049). Study discontinuation (n = 12) was associated with a higher rate of polypharmacy (p = 0.045), anxiety (HADS-A, p = 0.03), and specific fear of falling (FES-I, p = 0.025). In contrast, study completers (n = 8) reported an improvement in physical activity (PASE) (p = 0.018). In summary, pre-existing fall-risk factors impacted more falls than chemotherapy. A fall risk index offers a time-efficient screening option in an outpatient oncological setting.

Published
2023
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19. Assessment and Therapy of Chemotherapy-Induced Polyneuropathy: Update 2016

Author

Geber, C., Boehmerle, W., Lehmann, H. C., Hagenacker, T., Geber, C., Boehmerle, W., Lehmann, H. C., and Hagenacker, T.

Abstract

Chemotherapy-induced peripheral neuropathy (CIPN) is a debilitating and painful condition in patients undergoing treatment with commonly used agents such as platinum compounds, vinca alcaloids, taxanes, small molecules and antibody-based therapies. The incidence of CIPN is increasing as a consequence of better cancer treatments becoming available and increasing use of chemotherapy, and because it is a more frequently occurring side-effect with use of new chemotherapeutics. The mechanisms underlying this condition are diverse, and include an array of molecular and cellular contributions. Processes influenced by CIPN include increased expression of inflammatory mediators, changes in ion channels and neurotransmission, as well as changes in intracellular signaling and structures. Structural deficits in dorsal root ganglia and sensory nerves cause symptoms such as sensory loss, paresthesia, dysesthesia, numbness as well as neuropathic pain that result in patient suffering and also limit the therapeutic efficiency with a severe impairment of quality of life. DNA damage, alterations in cellular system repairs, mitochondrial changes, increased intracellular reactive oxygen species, glutamate signaling, MAP-kinases and nociceptor ectopic activation are among the events that trigger the onset of peripheral neurotoxicity and neuropathic pain. The diagnosis of CIPN is made principally on clinical grounds, and it is characterized by predominantly sensory symptoms. CIPN assessment relies mainly on patient-oriented questionnaires, but an international effort is ongoing to assess reliable and objective means to assess small and large fiber impairment. If CIPN occurs, the only effective strategies are dose reduction or discontinuation of chemotherapy. However, symptomatic treatment of mainly neuropathic pain symptoms is available and effective. The purpose of this review is to examine the basic mechanisms of neuropathy and currently available treatment options in the context of CIP

Published
2016

28. Pain in chemotherapy-induced neuropathy – More than neuropathic?

Author

Geber, C., Breimhorst, M., Burbach, B., Egenolf, C., Baier, B., Fechir, M., Koerber, J., Treede, R.D., Vogt, T., Birklein, F., Geber, C., Breimhorst, M., Burbach, B., Egenolf, C., Baier, B., Fechir, M., Koerber, J., Treede, R.D., Vogt, T., and Birklein, F.

Abstract

Chemotherapy-induced neuropathy (CIN) is an adverse effect of chemotherapy. Pain in CIN might comprise neuropathic and nonneuropathic (ie, musculoskeletal) pain components, which might be characterized by pain patterns, electrophysiology, and somatosensory profiling. Included were 146 patients (100 female, 46 male; aged 56 ± 0.8 years) with CIN arising from different chemotherapy regimens. Patients were characterized clinically through nerve conduction studies (NCS) and quantitative sensory testing (QST). Questionnaires for pain (McGill) and anxiety/depression (Hospital Anxiety and Depression Scale) were supplied. Patients were followed-up after 17 days. Large- (61%) and mixed- (35%) fibre neuropathies were more frequent than small-fibre neuropathy (1.4%). The 5 major chemotherapeutic regimens impacted differently on large- but not on small-fibre function and did not predict painfulness. Chronic pain associated with CIN was reported in 41.7%. Painless and painful CIN did not differ in QST profiles or electrophysiological findings, but different somatosensory patterns were found in CIN subgroups (pain at rest [RestP], n = 25; movement-associated pain [MovP], n = 15; both pain characteristics [MovP+RestP], n = 21; or no pain [NonP], n = 85): small-fibre function (cold-detection threshold, CDT: z score: −1.46 ± 0.21, P < 0.01) was most impaired in RestP; mechanical hyperalgesia was exclusively found in MovP (z score: +0.81 ± 0.30, P < 0.05). “Anxiety” discriminated between painful and painless CIN; “CDT” and “anxiety” discriminated between patients with ongoing (RestP) and movement-associated pain (MovP) or pain components (MovP+RestP). The detrimental effect of chemotherapy on large fibres failed to differentiate painful from painless CIN. Patients stratified for musculoskeletal or neuropathic pain, however, differed in psychological and somatosensory parameters. This stratification might allow for the application of a more specific therapy.

Published
2013

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