Benoliel R, Epstein J, Eliav E, Jurevic R, Elad S
Department of Oral Medicine, The Hebrew University, Hadassah Faculty of Dental Medicine, PO Box 12272, Jerusalem 91120, Israel.
J Dent Res. 2007 Jun;86(6):491-505. doi: 10.1177/154405910708600604.
The mechanisms involved, and possible treatment targets, in orofacial pain due to cancer are poorly understood. The aim of the first of this two-part series is to review the involved pathophysiological mechanisms and explore their possible roles in the orofacial region. However, there is a lack of relevant research in the trigeminal region, and we have therefore applied data accumulated from experiments on cancer pain mechanisms in rodent spinal models. In the second part, we review the clinical presentation of cancer-associated orofacial pain at various stages: initial diagnosis, during therapy (chemo-, radiotherapy, surgery), and in the post-therapy period. In the present article, we provide a brief outline of trigeminal functional neuro-anatomy and pain-modulatory pathways. Tissue destruction by invasive tumors (or metastases) induces inflammation and nerve damage, with attendant acute pain. In some cases, chronic pain, involving inflammatory and neuropathic mechanisms, may ensue. Distant, painful effects of tumors include paraneoplastic neuropathic syndromes and effects secondary to the release of factors by the tumor (growth factors, cytokines, and enzymes). Additionally, pain is frequent in cancer management protocols (surgery, chemotherapy, and radiotherapy). Understanding the mechanisms involved in cancer-related orofacial pain will enhance patient management.
人们对癌症引起的口腔面部疼痛所涉及的机制以及可能的治疗靶点了解甚少。这个两部分系列文章的第一篇旨在综述所涉及的病理生理机制，并探讨它们在口腔面部区域可能发挥的作用。然而，在三叉神经区域缺乏相关研究，因此我们应用了在啮齿动物脊髓模型中关于癌症疼痛机制的实验积累的数据。在第二部分中，我们将综述癌症相关口腔面部疼痛在各个阶段的临床表现：初始诊断、治疗期间（化疗、放疗、手术）以及治疗后阶段。在本文中，我们简要概述三叉神经功能神经解剖学和疼痛调节通路。侵袭性肿瘤（或转移瘤）造成的组织破坏会引发炎症和神经损伤，并伴有急性疼痛。在某些情况下，可能会继而出现涉及炎症和神经病理性机制的慢性疼痛。肿瘤的远处疼痛效应包括副肿瘤性神经病变综合征以及肿瘤释放因子（生长因子、细胞因子和酶）所产生的继发效应。此外，在癌症治疗方案（手术、化疗和放疗）中疼痛也很常见。了解癌症相关口腔面部疼痛所涉及的机制将有助于改善患者管理。
