Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia.
Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia; Royal Prince Alfred Hospital, Camperdown, Australia; Sydney Medical School, The University of Sydney, Australia.
J Pain. 2020 Jan-Feb;21(1-2):44-58. doi: 10.1016/j.jpain.2019.06.011. Epub 2019 Jul 17.
Chemotherapy-induced peripheral neuropathy (CIPN) is a major, dose-limiting side effect of treatment with neurotoxic cancer treatments which can result in long-term impairment. Deficits often reflect a large fiber polyneuropathy, however small fiber involvement resulting in neuropathic pain and autonomic dysfunction can occur. Quantification of both CIPN and small fiber neuropathy (SFN) remains a challenge. Accordingly, the prevalence and pathophysiology of small fiber neuropathy amongst cancer survivors remains poorly understood. This review will provide an overview of the clinical features of SFN associated with neurotoxic cancer treatments as well as a summary of current assessment tools for evaluating small fiber function, and their use in patients treated with neurotoxic chemotherapies. The continued development and utilization of novel measures quantifying small fiber involvement will help elucidate the pathophysiology underlying symptoms of CIPN and assist in informing treatment approaches. Accurately identifying subgroups of patients with neuropathic symptoms which may respond to existing pain medication may reduce the impact of CIPN and improve long-term quality of life as well as provide better categorization of patients for future clinical trials of neuroprotective and treatment strategies for CIPN. PERSPECTIVE: This review provides a critical analysis of SFN associated with neurotoxic cancer treatments and the assessment tools for evaluating small fiber dysfunction in cancer patients. Quantification of small fiber involvement in CIPN will assist in identifying subgroups of patients with neuropathic symptoms which may respond to existing pain medications.
化疗引起的周围神经病（CIPN）是神经毒性癌症治疗的主要剂量限制副作用，可导致长期损害。缺陷通常反映大纤维多发性神经病，但也可能发生导致神经病理性疼痛和自主神经功能障碍的小纤维受累。CIPN 和小纤维神经病（SFN）的量化仍然是一个挑战。因此，癌症幸存者中小纤维神经病的患病率和发病机制仍知之甚少。这篇综述将概述与神经毒性癌症治疗相关的 SFN 的临床特征，以及当前评估小纤维功能的评估工具及其在接受神经毒性化疗的患者中的应用。继续开发和利用定量小纤维受累的新措施将有助于阐明 CIPN 症状的病理生理学，并有助于为 CIPN 的治疗方法提供信息。准确识别可能对现有止痛药物有反应的神经病理性症状患者亚组可能会减轻 CIPN 的影响，提高长期生活质量，并为 CIPN 的神经保护和治疗策略的未来临床试验更好地分类患者。观点：这篇综述对与神经毒性癌症治疗相关的 SFN 以及评估癌症患者小纤维功能障碍的评估工具进行了批判性分析。CIPN 中小纤维受累的量化将有助于识别可能对现有止痛药物有反应的神经病理性症状患者亚组。
