Loureiro Joana, Costa-Pereira José Tiago, Pozza Daniel H, Tavares Isaura
Unit of Experimental Biology, Department of Biomedicine, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal.
I3S-Institute of Investigation and Innovation in Health, University of Porto, Rua Alfredo Allen 208, 4200-135 Porto, Portugal.
Biomedicines. 2025 May 1;13(5):1103. doi: 10.3390/biomedicines13051103.
As the number of cancer patients and survivors increases, we face a rising challenge: the long-term impact of the adverse effects of cancer treatment. One of the known adverse effects is chemotherapy-induced peripheral neuropathy (CIPN), which courses with pain complaints. The treatments of CIPN have reduced efficacy. The neurobiological causes of CIPN have been mainly ascribed to peripheral nerve damage, but recent studies show effects in the brain, namely in the descending pain modulatory systems. Physical exercise seems to be associated with better outcomes in CIPN patients, but the mechanisms underlying the effects have not been discussed, namely considering the recent results of the effects of CIPN in brain structures involved in pain modulation. In this critical review, we propose that the beneficial effects of exercise in CIPN also have central mechanisms, namely neuroinflammation and oxidative stress, as well as changes in the actions of neurotransmitters and neurotrophic factors, with a direct effect on optimizing the endogenous pain modulation, namely opioids, monoamines, and endocannabinoids. The effects are multifactorial, as mood improvement and the other psychological benefits of exercise should be considered. The emerging role of the microbiome, which is affected during CIPN, also needs to be considered. This review critically synthesizes the available literature to highlight how the neurobiological effects of physical exercise make it a promising strategy for managing CIPN, both from preventive and treatment perspectives.
随着癌症患者和幸存者数量的增加，我们面临着一个日益严峻的挑战：癌症治疗副作用的长期影响。已知的副作用之一是化疗引起的周围神经病变（CIPN），其伴有疼痛症状。CIPN的治疗效果有所降低。CIPN的神经生物学原因主要归因于周围神经损伤，但最近的研究表明其在大脑中也有影响，即在下行疼痛调节系统中。体育锻炼似乎与CIPN患者更好的预后相关，但尚未讨论其作用机制，尤其是考虑到CIPN对参与疼痛调节的脑结构影响的最新研究结果。在这篇批判性综述中，我们提出运动对CIPN的有益作用也有中枢机制，即神经炎症和氧化应激，以及神经递质和神经营养因子作用的变化，直接影响内源性疼痛调节的优化，即阿片类物质、单胺和内源性大麻素。这些影响是多因素的，因为应考虑情绪改善和运动的其他心理益处。还需要考虑在CIPN期间受到影响的微生物群的新作用。这篇综述批判性地综合了现有文献，以强调体育锻炼的神经生物学效应如何使其成为从预防和治疗角度管理CIPN的一种有前景策略。
