1
|
Inchingolo AM, Dipalma G, Inchingolo AD, Palumbo I, Guglielmo M, Morolla R, Mancini A, Inchingolo F. Advancing Postoperative Pain Management in Oral Cancer Patients: A Systematic Review. Pharmaceuticals (Basel) 2024; 17:542. [PMID: 38675500 PMCID: PMC11054702 DOI: 10.3390/ph17040542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/02/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
The goal of this review is to shed light on the management of orofacial discomfort after a cancer diagnosis in the head and neck region. A search was conducted on PubMed, Scopus, and Web of Science to identify studies on postoperative pain control in oral cancer. The review included open-access research, investigations into pain management, randomized clinical trials, retrospective studies, case-control studies, prospective studies, English-written studies, and full-text publications. Exclusion criteria included animal studies; in vitro studies; off-topic studies; reviews, case reports, letters, or comments; and non-English language. Three reviewers independently accessed databases and assigned a quality rating to the chosen articles. The review explores postoperative pain management in oral cancer patients; highlighting persistent opioid use; the efficacy of adjuvant drugs, such as gabapentin; and a multimodal approach. It emphasizes the need for personalized pain management, recognizing individual pain perception and tailoring interventions. Integrating pharmacological and non-pharmacological strategies is crucial for comprehensive pain management. The review also serves as a guide for future research, emphasizing the need for standardized methodologies and diverse participant populations.
Collapse
Affiliation(s)
| | - Gianna Dipalma
- Correspondence: (G.D.); (F.I.); Tel.: +39-339-698-9939 (G.D.); +39-331-211-1104 (F.I.)
| | | | | | | | | | | | - Francesco Inchingolo
- Correspondence: (G.D.); (F.I.); Tel.: +39-339-698-9939 (G.D.); +39-331-211-1104 (F.I.)
| |
Collapse
|
2
|
Donati CM, Galietta E, Cellini F, Di Rito A, Portaluri M, De Tommaso C, Santacaterina A, Tamburella C, Mammini F, Di Franco R, Parisi S, Cossa S, Bianculli A, Ziccarelli P, Ziccarelli L, Genovesi D, Caravatta L, Deodato F, Macchia G, Fiorica F, Napoli G, Cammelli S, Cavallini L, Buwenge M, Rossi R, Maltoni M, Morganti AG, Cilla S. Further Clarification of Pain Management Complexity in Radiotherapy: Insights from Modern Statistical Approaches. Cancers (Basel) 2024; 16:1407. [PMID: 38611085 PMCID: PMC11010980 DOI: 10.3390/cancers16071407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/18/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND The primary objective of this study was to assess the adequacy of analgesic care in radiotherapy (RT) patients, with a secondary objective to identify predictive variables associated with pain management adequacy using a modern statistical approach, integrating the Least Absolute Shrinkage and Selection Operator (LASSO) algorithm and the Classification and Regression Tree (CART) analysis. METHODS This observational, multicenter cohort study involved 1387 patients reporting pain or taking analgesic drugs from 13 RT departments in Italy. The Pain Management Index (PMI) served as the measure for pain control adequacy, with a PMI score < 0 indicating suboptimal management. Patient demographics, clinical status, and treatment-related factors were examined to discern the predictors of pain management adequacy. RESULTS Among the analyzed cohort, 46.1% reported inadequately managed pain. Non-cancer pain origin, breast cancer diagnosis, higher ECOG Performance Status scores, younger patient age, early assessment phase, and curative treatment intent emerged as significant determinants of negative PMI from the LASSO analysis. Notably, pain management was observed to improve as RT progressed, with a greater discrepancy between cancer (33.2% with PMI < 0) and non-cancer pain (73.1% with PMI < 0). Breast cancer patients under 70 years of age with non-cancer pain had the highest rate of negative PMI at 86.5%, highlighting a potential deficiency in managing benign pain in younger patients. CONCLUSIONS The study underscores the dynamic nature of pain management during RT, suggesting improvements over the treatment course yet revealing specific challenges in non-cancer pain management, particularly among younger breast cancer patients. The use of advanced statistical techniques for analysis stresses the importance of a multifaceted approach to pain management, one that incorporates both cancer and non-cancer pain considerations to ensure a holistic and improved quality of oncological care.
Collapse
Affiliation(s)
- Costanza Maria Donati
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (E.G.); (F.M.); (S.C.); (L.C.); (A.G.M.)
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy;
| | - Erika Galietta
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (E.G.); (F.M.); (S.C.); (L.C.); (A.G.M.)
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy;
| | - Francesco Cellini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (F.C.); (F.D.)
- Dipartimento Universitario Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Alessia Di Rito
- Radiotherapy Unit, IRCCS Istituto Tumori ‘Giovanni Paolo II’ Bari, 70124 Bari, Italy;
| | | | | | - Anna Santacaterina
- U.O. di Radioterapia AOOR PAPARDO PIEMONTE, 98121 Messina, Italy; (A.S.); (C.T.)
| | - Consuelo Tamburella
- U.O. di Radioterapia AOOR PAPARDO PIEMONTE, 98121 Messina, Italy; (A.S.); (C.T.)
| | - Filippo Mammini
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (E.G.); (F.M.); (S.C.); (L.C.); (A.G.M.)
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy;
| | - Rossella Di Franco
- Department of Radiation Oncology, Istituto Nazionale Tumori-IRCCS-Fodazione G. Pascale, 80131 Napoli, Italy;
| | - Salvatore Parisi
- Radioterapia Opera di S. Pio da Pietralcina, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy; (S.P.); (S.C.)
| | - Sabrina Cossa
- Radioterapia Opera di S. Pio da Pietralcina, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy; (S.P.); (S.C.)
| | - Antonella Bianculli
- Medical Physics Department, IRCCS-CROB—Centro di Riferimento Oncologico della Basilica, 85028 Rionero in Vulture, Italy
| | - Pierpaolo Ziccarelli
- U.O. Radioterapia Oncologica—S.O. Mariano Santo, 87100 Cosenza, Italy; (P.Z.); (L.Z.)
| | - Luigi Ziccarelli
- U.O. Radioterapia Oncologica—S.O. Mariano Santo, 87100 Cosenza, Italy; (P.Z.); (L.Z.)
| | - Domenico Genovesi
- Radiation Oncology Unit, SS Annunziata Hospital, G. D’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy; (D.G.); (L.C.)
- Department of Neuroscience, Imaging and Clinical Sciences, “G. D’Annunzio” University of Chieti-Pescara, 66013 Chieti, Italy
| | - Luciana Caravatta
- Radiation Oncology Unit, SS Annunziata Hospital, G. D’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy; (D.G.); (L.C.)
| | - Francesco Deodato
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy; (F.C.); (F.D.)
- Radiation Oncology Unit, Responsible Research Hospital, 86100 Campobasso, Italy;
| | - Gabriella Macchia
- Radiation Oncology Unit, Responsible Research Hospital, 86100 Campobasso, Italy;
| | - Francesco Fiorica
- U.O.C.di Radioterapia e Medicina Nucleare, Ospedale Mater Salutis di Legnago, 37045 Verona, Italy; (F.F.); (G.N.)
| | - Giuseppe Napoli
- U.O.C.di Radioterapia e Medicina Nucleare, Ospedale Mater Salutis di Legnago, 37045 Verona, Italy; (F.F.); (G.N.)
| | - Silvia Cammelli
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (E.G.); (F.M.); (S.C.); (L.C.); (A.G.M.)
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy;
| | - Letizia Cavallini
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (E.G.); (F.M.); (S.C.); (L.C.); (A.G.M.)
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy;
| | - Milly Buwenge
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy;
| | - Romina Rossi
- Palliative Care Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy;
| | - Marco Maltoni
- Medical Oncology Unit, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy;
| | - Alessio Giuseppe Morganti
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (E.G.); (F.M.); (S.C.); (L.C.); (A.G.M.)
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy;
| | - Savino Cilla
- Medical Physics Unit, Responsible Research Hospital, 86100 Campobasso, Italy;
| |
Collapse
|
3
|
Inyang KE, Evans CM, Heussner M, Petroff M, Reimers M, Vermeer PD, Tykocki N, Folger JK, Laumet G. HPV+ head and neck cancer-derived small extracellular vesicles communicate with TRPV1+ neurons to mediate cancer pain. Pain 2024; 165:608-620. [PMID: 37678566 PMCID: PMC10915104 DOI: 10.1097/j.pain.0000000000003045] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 06/15/2023] [Indexed: 09/09/2023]
Abstract
ABSTRACT Severe pain is often experienced by patients with head and neck cancer and is associated with a poor prognosis. Despite its frequency and severity, current treatments fail to adequately control cancer-associated pain because of our lack of mechanistic understanding. Although recent works have shed some light of the biology underlying pain in HPV-negative oral cancers, the mechanisms mediating pain in HPV+ cancers remain unknown. Cancer-derived small extracellular vesicles (cancer-sEVs) are well positioned to function as mediators of communication between cancer cells and neurons. Inhibition of cancer-sEV release attenuated pain in tumor-bearing mice. Injection of purified cancer-sEVs is sufficient to induce pain hypersensitivity in naive mice that is prevented by QX-314 treatment and in Trpv1-/- mice. Cancer-sEVs triggered calcium influx in nociceptors, and inhibition or ablation of nociceptors protects against cancer pain. Interrogation of published sequencing data of human sensory neurons exposed to human cancer-sEVs suggested a stimulation of protein translation in neurons. Induction of translation by cancer-sEVs was validated in our mouse model, and its inhibition alleviated cancer pain in mice. In summary, our work reveals that HPV+ head and neck squamous cell carcinoma-derived sEVs alter TRPV1+ neurons by promoting nascent translation to mediate cancer pain and identified several promising therapeutic targets to interfere with this pathway.
Collapse
Affiliation(s)
| | - Christine M. Evans
- Department of Physiology, Michigan State University, East Lansing, MI, USA
| | - Matthew Heussner
- Department of Physiology, Michigan State University, East Lansing, MI, USA
- College of Osteopathic Medicine, Michigan State University, East Lansing, MI
| | - Margaret Petroff
- Department of Pathology Michigan State University College of Veterinary Medicine, East Lansing, MI
| | - Mark Reimers
- Department of Physiology, Michigan State University, East Lansing, MI, USA
| | - Paola D. Vermeer
- Cancer Biology and Immunotherapies Group, Sanford Research, Sioux Falls, South Dakota
| | - Nathan Tykocki
- Department of Pharmacology and Toxicology, Michigan State University, East Lansing, MI
| | - Joseph K. Folger
- Department of Physiology, Michigan State University, East Lansing, MI, USA
| | - Geoffroy Laumet
- Department of Physiology, Michigan State University, East Lansing, MI, USA
| |
Collapse
|
4
|
Mardelle U, Bretaud N, Daher C, Feuillet V. From pain to tumor immunity: influence of peripheral sensory neurons in cancer. Front Immunol 2024; 15:1335387. [PMID: 38433844 PMCID: PMC10905387 DOI: 10.3389/fimmu.2024.1335387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/29/2024] [Indexed: 03/05/2024] Open
Abstract
The nervous and immune systems are the primary sensory interfaces of the body, allowing it to recognize, process, and respond to various stimuli from both the external and internal environment. These systems work in concert through various mechanisms of neuro-immune crosstalk to detect threats, provide defense against pathogens, and maintain or restore homeostasis, but can also contribute to the development of diseases. Among peripheral sensory neurons (PSNs), nociceptive PSNs are of particular interest. They possess a remarkable capability to detect noxious stimuli in the periphery and transmit this information to the brain, resulting in the perception of pain and the activation of adaptive responses. Pain is an early symptom of cancer, often leading to its diagnosis, but it is also a major source of distress for patients as the disease progresses. In this review, we aim to provide an overview of the mechanisms within tumors that are likely to induce cancer pain, exploring a range of factors from etiological elements to cellular and molecular mediators. In addition to transmitting sensory information to the central nervous system, PSNs are also capable, when activated, to produce and release neuropeptides (e.g., CGRP and SP) from their peripheral terminals. These neuropeptides have been shown to modulate immunity in cases of inflammation, infection, and cancer. PSNs, often found within solid tumors, are likely to play a significant role in the tumor microenvironment, potentially influencing both tumor growth and anti-tumor immune responses. In this review, we discuss the current state of knowledge about the degree of sensory innervation in tumors. We also seek to understand whether and how PSNs may influence the tumor growth and associated anti-tumor immunity in different mouse models of cancer. Finally, we discuss the extent to which the tumor is able to influence the development and functions of the PSNs that innervate it.
Collapse
Affiliation(s)
- Ugo Mardelle
- Aix-Marseille Université, Centre National de la Recherche Scientifique (CNRS), Institut National de la Santé et de la Recherche Médicale (INSERM), CIML, Centre d'Immunologie de Marseille-Luminy, Marseille, France
| | - Ninon Bretaud
- Aix-Marseille Université, Centre National de la Recherche Scientifique (CNRS), Institut National de la Santé et de la Recherche Médicale (INSERM), CIML, Centre d'Immunologie de Marseille-Luminy, Marseille, France
| | - Clara Daher
- Aix-Marseille Université, Centre National de la Recherche Scientifique (CNRS), Institut National de la Santé et de la Recherche Médicale (INSERM), CIML, Centre d'Immunologie de Marseille-Luminy, Marseille, France
| | - Vincent Feuillet
- Aix-Marseille Université, Centre National de la Recherche Scientifique (CNRS), Institut National de la Santé et de la Recherche Médicale (INSERM), CIML, Centre d'Immunologie de Marseille-Luminy, Marseille, France
| |
Collapse
|
5
|
Santi MD, Zhang M, Liu N, Viet CT, Xie T, Jensen DD, Amit M, Pan H, Ye Y. Repurposing EGFR Inhibitors for Oral Cancer Pain and Opioid Tolerance. Pharmaceuticals (Basel) 2023; 16:1558. [PMID: 38004424 PMCID: PMC10674507 DOI: 10.3390/ph16111558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/24/2023] [Accepted: 10/27/2023] [Indexed: 11/26/2023] Open
Abstract
Oral cancer pain remains a significant public health concern. Despite the development of improved treatments, pain continues to be a debilitating clinical feature of the disease, leading to reduced oral mobility and diminished quality of life. Opioids are the gold standard treatment for moderate-to-severe oral cancer pain; however, chronic opioid administration leads to hyperalgesia, tolerance, and dependence. The aim of this review is to present accumulating evidence that epidermal growth factor receptor (EGFR) signaling, often dysregulated in cancer, is also an emerging signaling pathway critically involved in pain and opioid tolerance. We presented preclinical and clinical data to demonstrate how repurposing EGFR inhibitors typically used for cancer treatment could be an effective pharmacological strategy to treat oral cancer pain and to prevent or delay the development of opioid tolerance. We also propose that EGFR interaction with the µ-opioid receptor and glutamate N-methyl-D-aspartate receptor could be two novel downstream mechanisms contributing to pain and morphine tolerance. Most data presented here support that repurposing EGFR inhibitors as non-opioid analgesics in oral cancer pain is promising and warrants further research.
Collapse
Affiliation(s)
- Maria Daniela Santi
- Translational Research Center, College of Dentistry, New York University, New York, NY 10010, USA; (M.D.S.); (M.Z.); (N.L.); (D.D.J.)
- Pain Research Center, Department of Molecular Pathobiology, College of Dentistry, New York University, New York, NY 10010, USA
| | - Morgan Zhang
- Translational Research Center, College of Dentistry, New York University, New York, NY 10010, USA; (M.D.S.); (M.Z.); (N.L.); (D.D.J.)
- Pain Research Center, Department of Molecular Pathobiology, College of Dentistry, New York University, New York, NY 10010, USA
| | - Naijiang Liu
- Translational Research Center, College of Dentistry, New York University, New York, NY 10010, USA; (M.D.S.); (M.Z.); (N.L.); (D.D.J.)
- Pain Research Center, Department of Molecular Pathobiology, College of Dentistry, New York University, New York, NY 10010, USA
| | - Chi T. Viet
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Loma Linda University, Loma Linda, CA 92350, USA;
| | - Tongxin Xie
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (T.X.); (M.A.)
| | - Dane D. Jensen
- Translational Research Center, College of Dentistry, New York University, New York, NY 10010, USA; (M.D.S.); (M.Z.); (N.L.); (D.D.J.)
- Pain Research Center, Department of Molecular Pathobiology, College of Dentistry, New York University, New York, NY 10010, USA
| | - Moran Amit
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (T.X.); (M.A.)
| | - Huilin Pan
- Center for Neuroscience and Pain Research, Department of Anesthesiology and Perioperative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Yi Ye
- Translational Research Center, College of Dentistry, New York University, New York, NY 10010, USA; (M.D.S.); (M.Z.); (N.L.); (D.D.J.)
- Pain Research Center, Department of Molecular Pathobiology, College of Dentistry, New York University, New York, NY 10010, USA
| |
Collapse
|
6
|
Ibrahim T, Wu P, Wang LJ, Fang-Mei C, Murillo J, Merlo J, Shein SS, Tumanov AV, Lai Z, Weldon K, Chen Y, Ruparel S. Sex-dependent differences in the genomic profile of lingual sensory neurons in naïve and tongue-tumor bearing mice. Sci Rep 2023; 13:13117. [PMID: 37573456 PMCID: PMC10423281 DOI: 10.1038/s41598-023-40380-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 08/09/2023] [Indexed: 08/14/2023] Open
Abstract
Mechanisms of sex-dependent orofacial pain are widely understudied. A significant gap in knowledge exists about comprehensive regulation of tissue-specific trigeminal sensory neurons in diseased state of both sexes. Using RNA sequencing of FACS sorted retro-labeled sensory neurons innervating tongue tissue, we determined changes in transcriptomic profiles in males and female mice under naïve as well as tongue-tumor bearing conditions Our data revealed the following interesting findings: (1) FACS sorting obtained higher number of neurons from female trigeminal ganglia (TG) compared to males; (2) Naïve female neurons innervating the tongue expressed immune cell markers such as Csf1R, C1qa and others, that weren't expressed in males. This was validated by Immunohistochemistry. (3) Accordingly, immune cell markers such as Csf1 exclusively sensitized TRPV1 responses in female TG neurons. (4) Male neurons were more tightly regulated than female neurons upon tumor growth and very few differentially expressed genes (DEGs) overlapped between the sexes, (5) Male DEGs contained higher number of transcription factors whereas female DEGs contained higher number of enzymes, cytokines and chemokines. Collectively, this is the first study to characterize the effect of sex as well as of tongue-tumor on global gene expression, pathways and molecular function of tongue-innervating sensory neurons.
Collapse
Affiliation(s)
- Tarek Ibrahim
- Department of Endodontics, School of Dentistry, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Ping Wu
- Department of Endodontics, School of Dentistry, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Li-Ju Wang
- Greehey Children's Cancer Institute, University of Texas Health San Antonio, San Antonio, USA
- Department of Population Health Sciences, University of Texas Health at San Antonio, San Antonio, USA
| | - Chang Fang-Mei
- Department of Endodontics, School of Dentistry, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Josue Murillo
- Department of Endodontics, School of Dentistry, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Jaclyn Merlo
- Department of Endodontics, School of Dentistry, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Sergey S Shein
- Department of Microbiology, Immunology and Molecular Genetics, University of Texas Health San Antonio, San Antonio, USA
| | - Alexei V Tumanov
- Department of Microbiology, Immunology and Molecular Genetics, University of Texas Health San Antonio, San Antonio, USA
| | - Zhao Lai
- Greehey Children's Cancer Institute, University of Texas Health San Antonio, San Antonio, USA
- Department of Molecular Medicine, University of Texas Health at San Antonio, San Antonio, TX, USA
| | - Korri Weldon
- Greehey Children's Cancer Institute, University of Texas Health San Antonio, San Antonio, USA
- Department of Molecular Medicine, University of Texas Health at San Antonio, San Antonio, TX, USA
| | - Yidong Chen
- Greehey Children's Cancer Institute, University of Texas Health San Antonio, San Antonio, USA
- Department of Population Health Sciences, University of Texas Health at San Antonio, San Antonio, USA
| | - Shivani Ruparel
- Department of Endodontics, School of Dentistry, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA.
| |
Collapse
|
7
|
Scheff NN, Harris AL, Li J, Horan NL, Kubik MW, Kim SW, Nilsen ML. Pretreatment pain predicts perineural invasion in patients with head and neck squamous cell carcinoma. Support Care Cancer 2023; 31:405. [PMID: 37341777 DOI: 10.1007/s00520-023-07872-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 06/09/2023] [Indexed: 06/22/2023]
Abstract
OBJECTIVES Perineural invasion (PNI) in head and neck cancer (HNC) is a distinct pathological feature used to indicate aggressive tumor behavior and drive treatment strategies. Our study examined the prevalence and predictors of PNI in HNC patients stratified by tumor site. STUDY DESIGN AND METHODS A retrospective analysis of head and neck squamous cell carcinoma (HNSCC) patients who underwent surgical resection at the University of Pittsburgh Medical Center between 2015 and 2018 was performed. Pretreatment pain was assessed at least 1 week before surgery using the Functional Assessment of Cancer Therapy-Head and Neck (FACT-H&N). Demographics, clinical characteristics, and concomitant medications were obtained from medical records. Patients with cancers at the oropharynx and non-oropharynx (i.e., cancer at oral cavity, mandible, larynx) sites were separately analyzed. Tumor blocks were obtained from 10 patients for histological evaluation of intertumoral nerve presence. RESULTS A total of 292 patients (202 males, median age = 60.94 ± 11.06) were assessed. Pain and PNI were significantly associated with higher T stage (p < 0.001) and tumor site (p < 0.001); patients with non-oropharynx tumors reported more pain and had a higher incidence of PNI compared to oropharynx tumors. However, multivariable analysis identified pain as a significant variable uniquely associated with PNI for both tumor sites. Evaluation of nerve presence in tumor tissue showed 5-fold higher nerve density in T2 oral cavity tumors compared to oropharyngeal tumors. CONCLUSIONS Our study finds that PNI is associated with pretreatment pain and tumor stage. These data support the need for additional research into the impact of tumor location when investigating targeted therapies of tumor regression.
Collapse
Affiliation(s)
- Nicole N Scheff
- Department of Neurobiology, University of Pittsburgh, Pittsburgh, PA, USA
- Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Alexandria L Harris
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA
| | - Jinhong Li
- Department of Biostatistics, University of Pittsburgh, School of Public Health, Pittsburgh, PA, USA
| | - Nicole L Horan
- Department of Neurobiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mark W Kubik
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA
| | - Seungwon W Kim
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA
| | - Marci L Nilsen
- Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA.
- Department of Acute and Tertiary Care, University of Pittsburgh, School of Nursing, Pittsburgh, PA, USA.
| |
Collapse
|
8
|
Ibrahim T, Wu P, Wang LJ, Fang-Mei C, Murillo J, Merlo J, Tumanov A, Lai Z, Weldon K, Chen Y, Ruparel S. Sex-dependent Differences in the Genomic Profile of Lingual Sensory Neurons in Naïve and Tongue-Tumor Bearing Mice. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.01.14.524011. [PMID: 36711730 PMCID: PMC9882171 DOI: 10.1101/2023.01.14.524011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Mechanisms of sex-dependent orofacial pain are widely understudied. A significant gap in knowledge exists about comprehensive regulation of tissue-specific trigeminal sensory neurons in diseased state of both sexes. Using RNA sequencing of FACS sorted retro-labeled sensory neurons innervating tongue tissue, we determined changes in transcriptomic profiles in males and female mice under naïve as well as tongue-tumor bearing conditions Our data revealed the following interesting findings: 1) Tongue tissue of female mice was innervated with higher number of trigeminal neurons compared to males; 2) Naïve female neurons innervating the tongue exclusively expressed immune cell markers such as Csf1R, C1qa and others, that weren't expressed in males. This was validated by Immunohistochemistry. 4) Accordingly, immune cell markers such as Csf1 exclusively sensitized TRPV1 responses in female TG neurons. 3) Male neurons were more tightly regulated than female neurons upon tumor growth and very few differentially expressed genes (DEGs) overlapped between the sexes, 5) Male DEGs contained higher number of transcription factors whereas female DEGs contained higher number of enzymes, cytokines and chemokines. Collectively, this is the first study to characterize the effect of sex as well as of tongue-tumor on global gene expression, pathways and molecular function of tongue-innervating sensory neurons.
Collapse
Affiliation(s)
- Tarek Ibrahim
- Department of Endodontics, School of Dentistry, University of Texas Health San Antonio, USA
| | - Ping Wu
- Department of Endodontics, School of Dentistry, University of Texas Health San Antonio, USA
| | - Li-Ju Wang
- Greehey Children’s Cancer Institute, University of Texas Health San Antonio, USA
- Department of Population Health Sciences, University of Texas Health at San Antonio, USA
| | - Chang Fang-Mei
- Department of Endodontics, School of Dentistry, University of Texas Health San Antonio, USA
| | - Josue Murillo
- Department of Endodontics, School of Dentistry, University of Texas Health San Antonio, USA
| | - Jaclyn Merlo
- Department of Endodontics, School of Dentistry, University of Texas Health San Antonio, USA
| | - Alexei Tumanov
- Department of Microbiology, Immunology and Molecular Genetics, University of Texas Health San Antonio, USA
| | - Zhao Lai
- Greehey Children’s Cancer Institute, University of Texas Health San Antonio, USA
- Department of Molecular Medicine, University of Texas Health at San Antonio, San Antonio, TX, USA
| | - Korri Weldon
- Greehey Children’s Cancer Institute, University of Texas Health San Antonio, USA
- Department of Molecular Medicine, University of Texas Health at San Antonio, San Antonio, TX, USA
| | - Yidong Chen
- Greehey Children’s Cancer Institute, University of Texas Health San Antonio, USA
- Department of Population Health Sciences, University of Texas Health at San Antonio, USA
| | - Shivani Ruparel
- Department of Endodontics, School of Dentistry, University of Texas Health San Antonio, USA
| |
Collapse
|
9
|
Ye Y, Cardoso DDM, Kayahara GM, Bernabé DG. A pilot study to improve pain phenotyping in head and neck cancer patients. FRONTIERS IN PAIN RESEARCH 2023; 4:1146667. [PMID: 37251594 PMCID: PMC10211332 DOI: 10.3389/fpain.2023.1146667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/24/2023] [Indexed: 05/31/2023] Open
Abstract
Pain associated with head and neck cancer (HNC) is difficult to manage and reduces quality of life. It has been increasingly recognized that HNC patients exhibit a wide range of pain symptoms. Here we developed an orofacial pain assessment questionnaire and conducted a pilot study to improve pain phenotyping in HNC patients at the diagnosis. The questionnaire captures the following pain characteristics: pain intensity, location, quality, duration, and frequency; the impact of pain on daily activities; changes in smell and food sensitivities. Twenty-five HNC patients completed the questionnaire. 88% patients reported pain at the site of tumor; 36% reported multiple pain sites. All patients with pain reported at least one neuropathic pain (NP) descriptor, 54.5% reported at least two NP descriptors. The most common descriptors were "burning" and "pins and needles". Most patients reported increased pain to sour or hot/spicy food/drinks, and to food with coarse/hard textures. Patients exhibited impaired oral function, especially chewing, talking, mouth/jaw opening, and eating. Tumor progression has a significant impact on pain. Nodal metastasis is linked to pain at multiple body sites. Patients with advanced tumor staging experience greater pain at the primary tumor site, when exposed to hot or spicy food/drinks or food with hard/coarse texture, or when eating or chewing. We conclude that HNC patients experience a wide range of pain symptoms with altered mechanical, chemical, and temperature sensation. Improved phenotyping and stratification of pain in HNC patients will help address the underlying etiology, which may enable personalized therapeutic approaches in the future.
Collapse
Affiliation(s)
- Yi Ye
- Translational Research Center, New York University College of Dentistry, New York, NY, United States
- Pain Research Center, Department of Molecular Pathobiology, New York University College of Dentistry, New York, NY, United States
| | - Diovana de Melo Cardoso
- Oral Oncology Center, São Paulo State University (UNESP), School of Dentistry, Araçatuba, São Paulo, Brazil
| | - Giseli Mitsuy Kayahara
- Oral Oncology Center, São Paulo State University (UNESP), School of Dentistry, Araçatuba, São Paulo, Brazil
| | - Daniel Galera Bernabé
- Oral Oncology Center, São Paulo State University (UNESP), School of Dentistry, Araçatuba, São Paulo, Brazil
| |
Collapse
|
10
|
Gonzales CB, De La Chapa JJ, Patwardhan AM, Hargreaves KM. Oral Cancer Pain Includes Thermal Allodynia That May Be Attenuated by Chronic Alcohol Consumption. Pharmaceuticals (Basel) 2023; 16:ph16040518. [PMID: 37111275 PMCID: PMC10142169 DOI: 10.3390/ph16040518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/15/2023] [Accepted: 03/30/2023] [Indexed: 04/03/2023] Open
Abstract
Background: Oral cancer is one of the most painful cancer types, and is often refractory to existing analgesics. Oral cancer patients frequently develop a tolerance to opioids, the mainstay of current cancer pain therapy, leaving them with limited therapeutic options. Thus, there is a great need to identify molecular mechanisms driving oral cancer pain in an effort to develop new analgesics. Previous reports demonstrate that oral cancer patients experience intense mechanical pain and pain in function. To date, no studies have examined thermal pain in oral cancer patients or the role that alcohol consumption plays in oral cancer pain. This study aims to evaluate patient-reported pain levels and thermal allodynia, potential molecular mechanisms mediating thermal allodynia, and the effects of alcohol consumption on patient-perceived pain. Methods: This study evaluated human oral squamous cell carcinoma (OSCC) cell lines for their ability to activate thermosensitive channels in vitro and validated these findings in a rat model of orofacial pain. Patient-reported pain in a south Texas OSCC cohort (n = 27) was examined using a visual analog scale (VAS). Covariant analysis examined variables such as tobacco and alcohol consumption, ethnicity, gender, and cancer stage. Results: We determined that OSCC secretes factors that stimulate both the Transient Receptor Potential Ankyrin type 1 channel (TRPA1; noxious cold sensor) and the Transient Receptor Potential Vanilloid type 1 channel (TRPV1; noxious heat sensor) in vitro and that OSCC-secreted factors sensitize TRPV1 nociceptors in vivo. These findings were validated in this cohort, in which allodynia to cold and heat were reported. Notably, subjects that reported regular alcohol consumption also reported lower pain scores for every type of pain tested, with significantly reduced cold-induced pain, aching pain, and burning pain. Conclusion: Oral cancer patients experience multiple types of cancer pain, including thermal allodynia. Alcohol consumption correlates with reduced OSCC pain and reduced thermal allodynia, which may be mediated by TRPA1 and TRPV1. Hence, reduced pain in these patients may contribute to a delay in seeking care, and thus a delay in early detection and treatment.
Collapse
Affiliation(s)
- Cara B. Gonzales
- Department of Comprehensive Dentistry, UT Health San Antonio, School of Dentistry, San Antonio, TX 78229, USA
- Mays Cancer Center, UT Health San Antonio, San Antonio, TX 78229, USA
| | - Jorge J. De La Chapa
- Department of Comprehensive Dentistry, UT Health San Antonio, School of Dentistry, San Antonio, TX 78229, USA
| | - Amol M. Patwardhan
- Department of Anesthesiology and Pain Management, UT Southwestern Medical Center, Dallas, TX 75390, USA
| | - Kenneth M. Hargreaves
- Department of Endodontics, UT Health San Antonio, School of Dentistry, San Antonio, TX 78229, USA
| |
Collapse
|
11
|
Atherton MA, Park S, Horan NL, Nicholson S, Dolan JC, Schmidt BL, Scheff NN. Sympathetic modulation of tumor necrosis factor alpha-induced nociception in the presence of oral squamous cell carcinoma. Pain 2023; 164:27-42. [PMID: 35714327 PMCID: PMC9582047 DOI: 10.1097/j.pain.0000000000002655] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 04/08/2022] [Indexed: 01/09/2023]
Abstract
ABSTRACT Head and neck squamous cell carcinoma (HNSCC) causes more severe pain and psychological stress than other types of cancer. Despite clinical evidence linking pain, stress, and cancer progression, the underlying relationship between pain and sympathetic neurotransmission in oral cancer is unknown. We found that human HNSCC tumors and mouse tumor tissue are innervated by peripheral sympathetic and sensory nerves. Moreover, β-adrenergic 1 and 2 receptors (β-ARs) are overexpressed in human oral cancer cell lines, and norepinephrine treatment increased β-AR2 protein expression as well as cancer cell proliferation in vitro. We have recently demonstrated that inhibition of tumor necrosis factor alpha (TNFα) signaling reduces oral cancer-induced nociceptive behavior. Norepinephrine-treated cancer cell lines secrete more TNFα which, when applied to tongue-innervating trigeminal neurons, evoked a larger Ca 2+ transient; TNF-TNFR inhibitor blocked the increase in the evoked Ca 2+ transient. Using an orthotopic xenograft oral cancer model, we found that mice demonstrated significantly less orofacial cancer-induced nociceptive behavior during systemic β-adrenergic inhibitory treatment with propranolol. Furthermore, chemical sympathectomy using guanethidine led to a significant reduction in tumor size and nociceptive behavior. We infer from these results that sympathetic signaling modulates oral cancer pain through TNFα secretion and tumorigenesis. Further investigation of the role of neurocancer communication in cancer progression and pain is warranted.
Collapse
Affiliation(s)
- Megan A Atherton
- Department of Neurobiology, University of Pittsburgh, Pittsburgh, PA, United States
- Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Stella Park
- Bluestone Center for Clinical Research, DDS Program, College of Dentistry, New York University, New York, NY, United States
| | - Nicole L Horan
- Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Samuel Nicholson
- Bluestone Center for Clinical Research, DDS Program, College of Dentistry, New York University, New York, NY, United States
| | - John C Dolan
- Bluestone Center for Clinical Research, DDS Program, College of Dentistry, New York University, New York, NY, United States
| | - Brian L Schmidt
- Bluestone Center for Clinical Research, DDS Program, College of Dentistry, New York University, New York, NY, United States
| | - Nicole N Scheff
- Department of Neurobiology, University of Pittsburgh, Pittsburgh, PA, United States
- Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| |
Collapse
|
12
|
Sawicki CM, Janal MN, Nicholson SJ, Wu AK, Schmidt BL, Albertson DG. Oral cancer patients experience mechanical and chemical sensitivity at the site of the cancer. BMC Cancer 2022; 22:1165. [PMID: 36368973 PMCID: PMC9650819 DOI: 10.1186/s12885-022-10282-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 11/04/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Oral cancer patients suffer severe chronic and mechanically-induced pain at the site of the cancer. Our clinical experience is that oral cancer patients report new sensitivity to spicy foods. We hypothesized that in cancer patients, mechanical and chemical sensitivity would be greater when measured at the cancer site compared to a contralateral matched normal site. METHODS We determined mechanical pain thresholds (MPT) on the right and left sides of the tongue of 11 healthy subjects, and at the cancer and contralateral matched normal site in 11 oral cancer patients in response to von Frey filaments in the range of 0.008 to 300 g (normally not reported as painful). We evaluated chemical sensitivity in 13 healthy subjects and seven cancer patients, who rated spiciness/pain on a visual analog scale in response to exposure to six paper strips impregnated with capsaicin (0-10 mM). RESULTS Mechanical detection thresholds (MDT) were recorded for healthy subjects, but not MPTs. By contrast, MPTs were measured at the site of the cancer in oral cancer patients (7/11 patients). No MPTs were measured at the cancer patients' contralateral matched normal sites. Measured MPTs were correlated with patients' responses to the University of California Oral Cancer Pain Questionnaire. Capsaicin sensitivity at the site of the cancer was evident in cancer patients by a leftward shift of the cancer site capsaicin dose-response curve compared to that of the patient's contralateral matched normal site. We detected no difference in capsaicin sensitivity on the right and left sides of tongues of healthy subjects. CONCLUSIONS Mechanical and chemical sensitivity testing was well tolerated by the majority of oral cancer patients. Sensitivity is greater at the site of the cancer than at a contralateral matched normal site.
Collapse
Affiliation(s)
- Caroline M. Sawicki
- grid.137628.90000 0004 1936 8753Department of Pediatric Dentistry, New York University College of Dentistry, 421 First Avenue, Room 233W, New York, NY 10010 USA
| | - Malvin N. Janal
- grid.137628.90000 0004 1936 8753Department of Epidemiology & Health Promotion, New York University College of Dentistry, Room 301, 433 First Avenue, New York, NY 10010 USA
| | - Samuel J. Nicholson
- grid.137628.90000 0004 1936 8753Department of Oral and Maxillofacial Surgery, New York University College of Dentistry, 421 First Avenue, Room 233W, New York, NY 10010 USA
| | - Angie K. Wu
- grid.137628.90000 0004 1936 8753Bluestone Center for Clinical Research, New York University College of Dentistry, 421 First Avenue, Room 233W, New York, NY 10010 USA
| | - Brian L. Schmidt
- grid.137628.90000 0004 1936 8753Department of Oral and Maxillofacial Surgery, New York University College of Dentistry, 421 First Avenue, Room 233W, New York, NY 10010 USA ,grid.137628.90000 0004 1936 8753Bluestone Center for Clinical Research, New York University College of Dentistry, 421 First Avenue, Room 233W, New York, NY 10010 USA ,grid.137628.90000 0004 1936 8753NYU Oral Cancer Center, New York University College of Dentistry, 421 First Avenue, Room 233W, New York, NY 10010 USA
| | - Donna G. Albertson
- grid.137628.90000 0004 1936 8753Department of Oral and Maxillofacial Surgery, New York University College of Dentistry, 421 First Avenue, Room 233W, New York, NY 10010 USA ,grid.137628.90000 0004 1936 8753Bluestone Center for Clinical Research, New York University College of Dentistry, 421 First Avenue, Room 233W, New York, NY 10010 USA ,grid.137628.90000 0004 1936 8753NYU Oral Cancer Center, New York University College of Dentistry, 421 First Avenue, Room 233W, New York, NY 10010 USA
| |
Collapse
|
13
|
Donati CM, Nardi E, Zamagni A, Siepe G, Mammini F, Cellini F, Di Rito A, Portaluri M, De Tommaso C, Santacaterina A, Tamburella C, Di Franco R, Parisi S, Cossa S, Fusco V, Bianculli A, Ziccarelli P, Ziccarelli L, Genovesi D, Caravatta L, Deodato F, Macchia G, Fiorica F, Napoli G, Buwenge M, Rossi R, Maltoni M, Morganti AG. Adequacy of Pain Treatment in Radiotherapy Departments: Results of a Multicenter Study on 2104 Patients (Arise). Cancers (Basel) 2022; 14:cancers14194660. [PMID: 36230582 PMCID: PMC9563985 DOI: 10.3390/cancers14194660] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/20/2022] [Accepted: 09/22/2022] [Indexed: 11/19/2022] Open
Abstract
Aim: The frequent inadequacy of pain management in cancer patients is well known. Moreover, the quality of analgesic treatment in patients treated with radiotherapy (RT) has only been rarely assessed. In order to study the latter topic, we conducted a multicenter, observational and prospective study based on the Pain Management Index (PMI) in RT Italian departments. Methods: We collected data on age, gender, tumor site and stage, performance status, treatment aim, and pain (type: CP—cancer pain, NCP—non-cancer pain, MP—mixed pain; intensity: NRS: Numeric Rating Scale). Furthermore, we analyzed the impact on PMI on these parameters, and we defined a pain score with values from 0 (NRS: 0, no pain) to 3 (NRS: 7−10: intense pain) and an analgesic score from 0 (pain medication not taken) to 3 (strong opioids). By subtracting the pain score from the analgesic score, we obtained the PMI value, considering cases with values < 0 as inadequate analgesic prescriptions. The Ethics Committees of the participating centers approved the study (ARISE-1 study). Results: Two thousand one hundred four non-selected outpatients with cancer and aged 18 years or older were enrolled in 13 RT departments. RT had curative and palliative intent in 62.4% and 37.6% patients, respectively. Tumor stage was non-metastatic in 57.3% and metastatic in 42.7% of subjects, respectively. Pain affected 1417 patients (CP: 49.5%, NCP: 32.0%; MP: 18.5%). PMI was < 0 in 45.0% of patients with pain. At multivariable analysis, inadequate pain management was significantly correlated with curative RT aim, ECOG performance status = 1 (versus both ECOG-PS3 and ECOG- PS4), breast cancer, non-cancer pain, and Central and South Italy RT Departments (versus Northern Italy).Conclusions: Pain management was less adequate in patients with more favorable clinical condition and stage. Educational and organizational strategies are needed in RT departments to reduce the non-negligible percentage of patients with inadequate analgesic therapy.
Collapse
Affiliation(s)
- Costanza M. Donati
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Radiation Oncology, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
- Correspondence: ; Tel.: +39-051-2143564
| | - Elena Nardi
- Medical Statistics, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
| | - Alice Zamagni
- Radiation Oncology, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
| | - Giambattista Siepe
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Filippo Mammini
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Radiation Oncology, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
| | - Francesco Cellini
- Dipartimento di Diagnostica per Immagini Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Radioterapia Oncologica, 00168 Roma, Italy
- Radioterapia Oncologica ed Ematologia, Dipartimento Universitario Diagnostica per Immagini, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168 Roma, Italy
| | - Alessia Di Rito
- IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy
| | | | | | | | | | - Rossella Di Franco
- S.C. di Radioterapia dell’Istituto Nazionale Tumori Pascale, 80131 Napoli, Italy
| | - Salvatore Parisi
- Radioterapia Opera di S. Pio da Pietralcina, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy
| | - Sabrina Cossa
- Radioterapia Opera di S. Pio da Pietralcina, Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy
| | | | | | | | - Luigi Ziccarelli
- U.O. Radioterapia Oncologica-S.O. Mariano Santo, 87100 Cosenza, Italy
| | - Domenico Genovesi
- Radioterapia Università degli Studi G. D’Annunzio, 66100 Chieti, Italy
| | - Luciana Caravatta
- Radioterapia Università degli Studi G. D’Annunzio, 66100 Chieti, Italy
| | - Francesco Deodato
- Radioterapia Oncologica ed Ematologia, Dipartimento Universitario Diagnostica per Immagini, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168 Roma, Italy
- Radiotherapy Unit, Gemelli Molise Hospital, Catholic University of Sacred Heart, 86100 Campobasso, Italy
| | - Gabriella Macchia
- Radiotherapy Unit, Gemelli Molise Hospital, Catholic University of Sacred Heart, 86100 Campobasso, Italy
| | - Francesco Fiorica
- U.O.C.di Radioterapia e Medicina Nucleare, Ospedale Mater Salutis di Legnago, 37045 Verona, Italy
| | - Giuseppe Napoli
- U.O.C.di Radioterapia e Medicina Nucleare, Ospedale Mater Salutis di Legnago, 37045 Verona, Italy
| | - Milly Buwenge
- Radiation Oncology, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
| | - Romina Rossi
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy
| | - Marco Maltoni
- Medical Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
| | - Alessio G. Morganti
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Radiation Oncology, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
| |
Collapse
|
14
|
Horan NL, McIlvried LA, Atherton MA, Yuan MM, Dolan JC, Scheff NN. The impact of tumor immunogenicity on cancer pain phenotype using syngeneic oral cancer mouse models. FRONTIERS IN PAIN RESEARCH 2022; 3:991725. [PMID: 36172037 PMCID: PMC9512086 DOI: 10.3389/fpain.2022.991725] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 08/12/2022] [Indexed: 11/13/2022] Open
Abstract
Head and neck squamous cell carcinoma (HNSCC) patients report severe function-induced pain at the site of the primary tumor. The current hypothesis is that oral cancer pain is initiated and maintained in the cancer microenvironment due to secretion of algogenic mediators from tumor cells and surrounding immune cells that sensitize the primary sensory neurons innervating the tumor. Immunogenicity, which is the ability to induce an adaptive immune response, has been widely studied using cancer cell transplantation experiments. However, oral cancer pain studies have primarily used xenograft transplant models in which human-derived tumor cells are inoculated in an athymic mouse lacking an adaptive immune response; the role of inflammation in oral cancer-induced nociception is still unknown. Using syngeneic oral cancer mouse models, we investigated the impact of tumor cell immunogenicity and growth on orofacial nociceptive behavior and oral cancer-induced sensory neuron plasticity. We found that an aggressive, weakly immunogenic mouse oral cancer cell line, MOC2, induced rapid orofacial nociceptive behavior in both male and female C57Bl/6 mice. Additionally, MOC2 tumor growth invoked a substantial injury response in the trigeminal ganglia as defined by a significant upregulation of injury response marker ATF3 in tongue-innervating trigeminal neurons. In contrast, using a highly immunogenic mouse oral cancer cell line, MOC1, we found a much slower onset of orofacial nociceptive behavior in female C57Bl/6 mice only as well as sex-specific differences in the tumor-associated immune landscape and gene regulation in tongue innervating sensory neurons. Together, these data suggest that cancer-induced nociceptive behavior and sensory neuron plasticity can greatly depend on the immunogenic phenotype of the cancer cell line and the associated immune response.
Collapse
Affiliation(s)
- Nicole L. Horan
- Department of Neurobiology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Lisa A. McIlvried
- Department of Neurobiology, University of Pittsburgh, Pittsburgh, PA, United States
- Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Megan A. Atherton
- Department of Neurobiology, University of Pittsburgh, Pittsburgh, PA, United States
- Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Mona M. Yuan
- Department of Neurobiology, University of Pittsburgh, Pittsburgh, PA, United States
| | - John C. Dolan
- College of Dentistry, New York University, New York, NY, United States
| | - Nicole N. Scheff
- Department of Neurobiology, University of Pittsburgh, Pittsburgh, PA, United States
- Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
- *Correspondence: Nicole N. Scheff
| |
Collapse
|
15
|
Doan C, Aouizerat BE, Ye Y, Dang D, Asam K, Bhattacharya A, Howard T, Patel YK, Viet DT, Figueroa JD, Zhong JF, Thomas CM, Morlandt AB, Yu G, Callahan NF, Allen CT, Grandhi A, Herford AS, Walker PC, Nguyen K, Kidd SC, Lee SC, Inman JC, Slater JM, Viet CT. Neurotrophin Pathway Receptors NGFR and TrkA Control Perineural Invasion, Metastasis, and Pain in Oral Cancer. Adv Biol (Weinh) 2022; 6:e2200190. [PMID: 35925599 PMCID: PMC9533666 DOI: 10.1002/adbi.202200190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/14/2022] [Indexed: 01/28/2023]
Abstract
Oral squamous cell carcinoma (OSCC) patients suffer from poor survival due to metastasis or locoregional recurrence, processes that are both facilitated by perineural invasion (PNI). OSCC has higher rates of PNI than other cancer subtypes, with PNI present in 80% of tumors. Despite the impact of PNI on oral cancer prognosis and pain, little is known about the genes that drive PNI, which in turn drive pain, invasion, and metastasis. In this study, clinical data, preclinical, and in vitro models are leveraged to elucidate the role of neurotrophins in OSCC metastasis, PNI, and pain. The expression data in OSCC patients with metastasis, PNI, or pain demonstrate dysregulation of neurotrophin genes. TrkA and nerve growth factor receptor (NGFR) are focused, two receptors that are activated by NGF, a neurotrophin expressed at high levels in OSCC. It is demonstrated that targeted knockdown of these two receptors inhibits proliferation and invasion in an in vitro and preclinical model of OSCC, and metastasis, PNI, and pain. It is further determined that TrkA knockdown alone inhibits thermal hyperalgesia, whereas NGFR knockdown alone inhibits mechanical allodynia. Collectively the results highlight the ability of OSCC to co-opt different components of the neurotrophin pathway in metastasis, PNI, and pain.
Collapse
Affiliation(s)
- Coleen Doan
- Department of Oral & Maxillofacial Surgery, Loma Linda University School of Dentistry, Loma Linda, CA
| | - Bradley E. Aouizerat
- Department of Oral & Maxillofacial Surgery, New York University College of Dentistry, NY, United States
- Bluestone Center for Clinical Research, New York University College of Dentistry, NY, United States
| | - Yi Ye
- Department of Oral & Maxillofacial Surgery, New York University College of Dentistry, NY, United States
- Bluestone Center for Clinical Research, New York University College of Dentistry, NY, United States
| | - Dongmin Dang
- Department of Oral & Maxillofacial Surgery, New York University College of Dentistry, NY, United States
- Bluestone Center for Clinical Research, New York University College of Dentistry, NY, United States
| | - Kesava Asam
- Department of Oral & Maxillofacial Surgery, New York University College of Dentistry, NY, United States
- Bluestone Center for Clinical Research, New York University College of Dentistry, NY, United States
| | - Aditi Bhattacharya
- Department of Oral & Maxillofacial Surgery, New York University College of Dentistry, NY, United States
- Bluestone Center for Clinical Research, New York University College of Dentistry, NY, United States
| | - Timothy Howard
- Bluestone Center for Clinical Research, New York University College of Dentistry, NY, United States
| | - Yogin K. Patel
- Bluestone Center for Clinical Research, New York University College of Dentistry, NY, United States
| | - Dan T. Viet
- Bluestone Center for Clinical Research, New York University College of Dentistry, NY, United States
| | - Johnny D. Figueroa
- Department of Basic Sciences, Center for Health Disparities and Molecular Medicine, Loma Linda University School of Medicine, Loma Linda, CA, United States
| | - Jiang F. Zhong
- Department of Basic Sciences, Loma Linda University, School of Medicine, Loma Linda, CA
| | - Carissa M. Thomas
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, AL
| | - Anthony B. Morlandt
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, AL
- Department of Oral and Maxillofacial Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Gary Yu
- Rory Meyers College of Nursing, New York University, New York, NY
| | - Nicholas F. Callahan
- Department of Oral and Maxillofacial Surgery, University of Illinois Chicago, College of Dentistry, Chicago, IL
| | - Clint T. Allen
- Section on Translational Tumor Immunology, National Institute on Deafness and Other Communication Disorders (NIDCD), National Institutes of Health (NIH), Bethesda, MD
| | - Anupama Grandhi
- Department of Oral & Maxillofacial Surgery, Loma Linda University School of Dentistry, Loma Linda, CA
| | - Alan S. Herford
- Department of Oral & Maxillofacial Surgery, Loma Linda University School of Dentistry, Loma Linda, CA
| | - Paul C. Walker
- Department of Otolaryngology, Loma Linda University School of Medicine, Loma Linda, CA
| | - Khanh Nguyen
- Department of Otolaryngology, Loma Linda University School of Medicine, Loma Linda, CA
| | - Stephanie C. Kidd
- Department of Otolaryngology, Loma Linda University School of Medicine, Loma Linda, CA
| | - Steve C. Lee
- Department of Otolaryngology, Loma Linda University School of Medicine, Loma Linda, CA
| | - Jared C. Inman
- Department of Otolaryngology, Loma Linda University School of Medicine, Loma Linda, CA
| | - Jason M. Slater
- Department of Radiation Medicine, Loma Linda University School of Medicine, Loma Linda, CA
| | - Chi T. Viet
- Department of Oral & Maxillofacial Surgery, Loma Linda University School of Dentistry, Loma Linda, CA
| |
Collapse
|
16
|
Dubeykovskaya ZA, Tu NH, Garcia PDR, Schmidt BL, Albertson DG. Oral Cancer Cells Release Vesicles that Cause Pain. Adv Biol (Weinh) 2022; 6:e2200073. [PMID: 35802912 PMCID: PMC9474716 DOI: 10.1002/adbi.202200073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/02/2022] [Indexed: 01/28/2023]
Abstract
Oral cancer pain is attributed to the release from cancers of mediators that sensitize and activate sensory neurons. Intraplantar injection of conditioned media (CM) from human tongue cancer cell line HSC-3 or OSC-20 evokes nociceptive behavior. By contrast, CM from noncancer cell lines, DOK, and HaCaT are non-nociceptive. Pain mediators are carried by extracellular vesicles (EVs) released from cancer cells. Depletion of EVs from cancer cell line CM reverses mechanical allodynia and thermal hyperalgesia. CM from non-nociceptive cell lines become nociceptive when reconstituted with HSC-3 EVs. Two miRNAs (hsa-miR-21-5p and hsa-miR-221-3p) are identified that are present in increased abundance in EVs from HSC-3 and OSC-20 CM compared to HaCaT CM. The miRNA target genes suggest potential involvement in oral cancer pain of the toll like receptor 7 (TLR7) and 8 (TLR8) pathways, as well as signaling through interleukin 6 cytokine family signal transducer receptor (gp130, encoded by IL6ST) and colony stimulating factor receptor (G-CSFR, encoded by CSF3R), Janus kinase and signal transducer and activator of transcription 3 (JAK/STAT3). These studies confirm the recent discovery of the role of cancer EVs in pain and add to the repertoire of algesic and analgesic cancer pain mediators and pathways that contribute to oral cancer pain.
Collapse
Affiliation(s)
- Zinaida A Dubeykovskaya
- Bluestone Center for Clinical Research and Department of Oral and Maxillofacial Surgery, New York University College of Dentistry, New York, NY, 10010, USA
| | - Nguyen Huu Tu
- Bluestone Center for Clinical Research and Department of Oral and Maxillofacial Surgery, New York University College of Dentistry, New York, NY, 10010, USA
| | - Paulina D Ramírez Garcia
- Bluestone Center for Clinical Research and Department of Oral and Maxillofacial Surgery, New York University College of Dentistry, New York, NY, 10010, USA
| | - Brian L Schmidt
- Bluestone Center for Clinical Research and Department of Oral and Maxillofacial Surgery, New York University College of Dentistry, New York, NY, 10010, USA
| | - Donna G Albertson
- Bluestone Center for Clinical Research and Department of Oral and Maxillofacial Surgery, New York University College of Dentistry, New York, NY, 10010, USA
| |
Collapse
|
17
|
Characteristics and prevalence of orofacial pain as an initial symptom of oral and oropharyngeal cancer and its impact on the patient's functionality and quality of life. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 134:457-464. [DOI: 10.1016/j.oooo.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/01/2022] [Accepted: 07/05/2022] [Indexed: 11/19/2022]
|
18
|
Fadu head and neck squamous cell carcinoma induces hyperexcitability of primary sensory neurons in an in vitro coculture model. Pain Rep 2022; 7:e1012. [PMID: 35620249 PMCID: PMC9113206 DOI: 10.1097/pr9.0000000000001012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 04/08/2022] [Accepted: 04/14/2022] [Indexed: 11/03/2022] Open
Abstract
Supplemental Digital Content is Available in the Text. Squamouscell carcinoma cells promoted an inflammatory microenvironment and induced sensitization of both human and rat dorsal root ganglion neurons in patch clamp electrophysiology recordings. Introduction: Methods: Results: Conclusions:
Collapse
|
19
|
Ye Y, Jensen DD, Viet CT, Pan HL, Campana WM, Amit M, Boada MD. Advances in Head and Neck Cancer Pain. J Dent Res 2022; 101:1025-1033. [PMID: 35416080 PMCID: PMC9305840 DOI: 10.1177/00220345221088527] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Head and neck cancer (HNC) affects over 890,000 people annually worldwide and has a mortality rate of 50%. Aside from poor survival, HNC pain impairs eating, drinking, and talking in patients, severely reducing quality of life. Different pain phenotype in patients (allodynia, hyperalgesia, and spontaneous pain) results from a combination of anatomical, histopathological, and molecular differences between cancers. Poor pathologic features (e.g., perineural invasion, lymph node metastasis) are associated with increased pain. The use of syngeneic/immunocompetent animal models, as well as a new mouse model of perineural invasion, provides novel insights into the pathobiology of HNC pain. Glial and immune modulation of the tumor microenvironment affect not only cancer progression but also pain signaling. For example, Schwann cells promote cancer cell proliferation, migration, and secretion of nociceptive mediators, whereas neutrophils are implicated in sex differences in pain in animal models of HNC. Emerging evidence supports the existence of a functional loop of cross-activation between the tumor microenvironment and peripheral nerves, mediated by a molecular exchange of bioactive contents (pronociceptive and protumorigenic) via paracrine and autocrine signaling. Brain-derived neurotrophic factor, tumor necrosis factor α, legumain, cathepsin S, and A disintegrin and metalloprotease 17 expressed in the HNC microenvironment have recently been shown to promote HNC pain, further highlighting the importance of proinflammatory cytokines, neurotrophic factors, and proteases in mediating HNC-associated pain. Pronociceptive mediators, together with nerve injury, cause nociceptor hypersensitivity. Oncogenic, pronociceptive mediators packaged in cancer cell-derived exosomes also induce nociception in mice. In addition to increased production of pronociceptive mediators, HNC is accompanied by a dampened endogenous antinociception system (e.g., downregulation of resolvins and µ-opioid receptor expression). Resolvin treatment or gene delivery of µ-opioid receptors provides pain relief in preclinical HNC models. Collectively, recent studies suggest that pain and HNC progression share converging mechanisms that can be targeted for cancer treatment and pain management.
Collapse
Affiliation(s)
- Y Ye
- Bluestone Center for Clinical Research, New York University College of Dentistry, New York, NY, USA.,Department of Molecular Pathobiology, New York University College of Dentistry, New York, NY, USA
| | - D D Jensen
- Bluestone Center for Clinical Research, New York University College of Dentistry, New York, NY, USA.,Department of Molecular Pathobiology, New York University College of Dentistry, New York, NY, USA
| | - C T Viet
- Department of Oral and Maxillofacial Surgery, Loma Linda University School of Dentistry, Loma Linda, CA, USA
| | - H L Pan
- Center for Neuroscience and Pain Research, Department of Anesthesiology and Perioperative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - W M Campana
- Department of Anesthesiology, School of Medicine, University of California, San Diego, CA, USA.,San Diego Veterans Health System, San Diego, CA, USA
| | - M Amit
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - M D Boada
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| |
Collapse
|
20
|
Oral cancer induced TRPV1 sensitization is mediated by PAR 2 signaling in primary afferent neurons innervating the cancer microenvironment. Sci Rep 2022; 12:4121. [PMID: 35260737 PMCID: PMC8904826 DOI: 10.1038/s41598-022-08005-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 02/22/2022] [Indexed: 11/29/2022] Open
Abstract
Oral cancer patients report sensitivity to spicy foods and liquids. The mechanism responsible for chemosensitivity induced by oral cancer is not known. We simulate oral cancer-induced chemosensitivity in a xenograft oral cancer mouse model using two-bottle choice drinking and conditioned place aversion assays. An anatomic basis of chemosensitivity is shown in increased expression of TRPV1 in anatomically relevant trigeminal ganglion (TG) neurons in both the xenograft and a carcinogen (4-nitroquinoline 1-oxide)-induced oral cancer mouse models. The percent of retrograde labeled TG neurons that respond to TRPV1 agonist, capsaicin, is increased along with the magnitude of response as measured by calcium influx, in neurons from the cancer models. To address the possible mechanism of TRPV1 sensitivity in tongue afferents, we study the role of PAR2, which can sensitize the TRPV1 channel. We show co-expression of TRPV1 and PAR2 on tongue afferents and using a conditioned place aversion assay, demonstrate that PAR2 mediates oral cancer-induced, TRPV1-evoked sensitivity in an oral cancer mouse model. The findings provide insight into oral cancer-mediated chemosensitivity.
Collapse
|
21
|
Dos Santos Alves JM, Viana KF, Pereira AF, Lima Júnior RCP, Vale ML, Pereira KMA, Gondim DV. Oral carcinogenesis triggers a nociceptive behavior and c-Fos expression in rats' trigeminal pathway. Oral Dis 2022; 29:1531-1541. [PMID: 35244314 DOI: 10.1111/odi.14176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 02/08/2022] [Accepted: 02/23/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To recognize changes that occur along the trigeminal pathway in oral cancer in order to establish an effective approach to pain control. METHODS Wistar rats were divided into control and 4-NQO-groups for 8, 12, 16, or 20 weeks. 4-NQO suspension was administered on the animals` tongues. Mechanical hyperalgesia, assessment of facial expressions and an open field test were performed. After euthanasia, the animals' tongues were removed for macro and microscopic analysis. c-Fos expression was analyzed in the trigeminal pathway structures. RESULTS 4-NQO induced time-dependent macroscopic lesions that were compatible with neoplastic tumors. Histopathological analysis confirmed oral squamous cell carcinoma in 50% of the animals on the 20th week. There was a significant nociceptive threshold reduction during the first two weeks, followed by a threshold return to the baseline levels, decreasing again from the 12th week. Facial nociceptive expression scores were observed on the 20th week, while increased grooming and exploratory activity were observed on the 8th week. Trigeminal ganglion showed an increased c-Fos immunoexpression on the 20th week and in the trigeminal subnucleus caudalis, it occurred on the 16th and 20th. The long-term carcinogenic exposure caused changes in the nociceptive behavior and c-Fos expression in the rats' trigeminal pathway.
Collapse
Affiliation(s)
- Joana Maria Dos Santos Alves
- Postgraduate Program in Dentistry, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Brazil
| | - Khalil Fernandes Viana
- Postgraduate Program in Dentistry, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Brazil
| | - Anamaria Falcão Pereira
- Drug Research and Development Center, Department of Physiology and Pharmacology, Faculty of Medicine, Federal University of Ceará, Brazil
| | - Roberto César Pereira Lima Júnior
- Drug Research and Development Center, Department of Physiology and Pharmacology, Faculty of Medicine, Federal University of Ceará, Brazil
| | - Mariana Lima Vale
- Drug Research and Development Center, Department of Physiology and Pharmacology, Faculty of Medicine, Federal University of Ceará, Brazil
| | - Karuza Maria Alves Pereira
- Postgraduate Program in Dentistry, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Brazil
| | - Delane Viana Gondim
- Postgraduate Program in Dentistry, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Brazil
| |
Collapse
|
22
|
Oral squamous cell carcinoma-released brain-derived neurotrophic factor contributes to oral cancer pain by peripheral tropomyosin receptor kinase B activation. Pain 2022; 163:496-507. [PMID: 34321412 PMCID: PMC8678394 DOI: 10.1097/j.pain.0000000000002382] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 06/14/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Oral cancer pain is debilitating and understanding mechanisms for it is critical to develop novel treatment strategies treatment strategies. Brain-derived neurotrophic factor (BDNF) signaling is elevated in oral tumor biopsies and is involved with tumor progression. Whether BDNF signaling in oral tumors contributes to cancer-induced pain is not known. The current study evaluates a novel peripheral role of BDNF-tropomyosin receptor kinase B (TrkB) signaling in oral cancer pain. Using human oral squamous cell carcinoma (OSCC) cells and an orthotopic mouse tongue cancer pain model, we found that BDNF levels were upregulated in superfusates and lysates of tumor tongues and that BDNF was expressed by OSCC cells themselves. Moreover, neutralization of BDNF or inhibition of TrkB activity by ANA12, within the tumor-bearing tongue reversed tumor-induced pain-like behaviors in a sex-dependent manner. Oral squamous cell carcinoma conditioned media also produced pain-like behaviors in naïve male mice that was reversed by local injection of ANA12. On a physiological level, using single-fiber tongue-nerve electrophysiology, we found that acutely blocking TrkB receptors reversed tumor-induced mechanical sensitivity of A-slow high threshold mechanoreceptors. Furthermore, single-cell reverse transcription polymerase chain reaction data of retrogradely labeled lingual neurons demonstrated expression of full-form TrkB and truncated TrkB in distinct neuronal subtypes. Last but not the least, intra-TG siRNA for TrkB also reversed tumor-induced orofacial pain behaviors. Our data suggest that TrkB activities on lingual sensory afferents are partly controlled by local release of OSCC-derived BDNF, thereby contributing to oral cancer pain. This is a novel finding and the first demonstration of a peripheral role for BDNF signaling in oral cancer pain.
Collapse
|
23
|
Tu NH, Inoue K, Chen E, Anderson BM, Sawicki CM, Scheff NN, Tran HD, Kim DH, Alemu RG, Yang L, Dolan JC, Liu CZ, Janal MN, Latorre R, Jensen DD, Bunnett NW, Edgington-Mitchell LE, Schmidt BL. Cathepsin S Evokes PAR 2-Dependent Pain in Oral Squamous Cell Carcinoma Patients and Preclinical Mouse Models. Cancers (Basel) 2021; 13:4697. [PMID: 34572924 PMCID: PMC8466361 DOI: 10.3390/cancers13184697] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 09/13/2021] [Indexed: 01/06/2023] Open
Abstract
Oral squamous cell carcinoma (SCC) pain is more prevalent and severe than pain generated by any other form of cancer. We previously showed that protease-activated receptor-2 (PAR2) contributes to oral SCC pain. Cathepsin S is a lysosomal cysteine protease released during injury and disease that can activate PAR2. We report here a role for cathepsin S in PAR2-dependent cancer pain. We report that cathepsin S was more active in human oral SCC than matched normal tissue, and in an orthotopic xenograft tongue cancer model than normal tongue. The multiplex immunolocalization of cathepsin S in human oral cancers suggests that carcinoma and macrophages generate cathepsin S in the oral cancer microenvironment. After cheek or paw injection, cathepsin S evoked nociception in wild-type mice but not in mice lacking PAR2 in Nav1.8-positive neurons (Par2Nav1.8), nor in mice treated with LY3000328 or an endogenous cathepsin S inhibitor (cystatin C). The human oral SCC cell line (HSC-3) with homozygous deletion of the gene for cathepsin S (CTSS) with CRISPR/Cas9 provoked significantly less mechanical allodynia and thermal hyperalgesia, as did those treated with LY3000328, compared to the control cancer mice. Our results indicate that cathepsin S is activated in oral SCC, and that cathepsin S contributes to cancer pain through PAR2 on neurons.
Collapse
Affiliation(s)
- Nguyen Huu Tu
- Bluestone Center for Clinical Research, Department of Oral and Maxillofacial Surgery, New York University (NYU) College of Dentistry, New York, NY 10010, USA; (N.H.T.); (K.I.); (E.C.); (C.M.S.); (N.N.S.); (H.D.T.); (D.H.K.); (R.G.A.); (L.Y.); (J.C.D.); (D.D.J.)
| | - Kenji Inoue
- Bluestone Center for Clinical Research, Department of Oral and Maxillofacial Surgery, New York University (NYU) College of Dentistry, New York, NY 10010, USA; (N.H.T.); (K.I.); (E.C.); (C.M.S.); (N.N.S.); (H.D.T.); (D.H.K.); (R.G.A.); (L.Y.); (J.C.D.); (D.D.J.)
| | - Elyssa Chen
- Bluestone Center for Clinical Research, Department of Oral and Maxillofacial Surgery, New York University (NYU) College of Dentistry, New York, NY 10010, USA; (N.H.T.); (K.I.); (E.C.); (C.M.S.); (N.N.S.); (H.D.T.); (D.H.K.); (R.G.A.); (L.Y.); (J.C.D.); (D.D.J.)
| | - Bethany M. Anderson
- Department of Biochemistry and Pharmacology, Bio21 Institute, University of Melbourne, Parkville, VIC 3052, Australia;
| | - Caroline M. Sawicki
- Bluestone Center for Clinical Research, Department of Oral and Maxillofacial Surgery, New York University (NYU) College of Dentistry, New York, NY 10010, USA; (N.H.T.); (K.I.); (E.C.); (C.M.S.); (N.N.S.); (H.D.T.); (D.H.K.); (R.G.A.); (L.Y.); (J.C.D.); (D.D.J.)
| | - Nicole N. Scheff
- Bluestone Center for Clinical Research, Department of Oral and Maxillofacial Surgery, New York University (NYU) College of Dentistry, New York, NY 10010, USA; (N.H.T.); (K.I.); (E.C.); (C.M.S.); (N.N.S.); (H.D.T.); (D.H.K.); (R.G.A.); (L.Y.); (J.C.D.); (D.D.J.)
- Hillman Cancer Research Center, Department of Neurobiology, University of Pittsburgh, Pittsburgh, PA 15232, USA
| | - Hung D. Tran
- Bluestone Center for Clinical Research, Department of Oral and Maxillofacial Surgery, New York University (NYU) College of Dentistry, New York, NY 10010, USA; (N.H.T.); (K.I.); (E.C.); (C.M.S.); (N.N.S.); (H.D.T.); (D.H.K.); (R.G.A.); (L.Y.); (J.C.D.); (D.D.J.)
| | - Dong H. Kim
- Bluestone Center for Clinical Research, Department of Oral and Maxillofacial Surgery, New York University (NYU) College of Dentistry, New York, NY 10010, USA; (N.H.T.); (K.I.); (E.C.); (C.M.S.); (N.N.S.); (H.D.T.); (D.H.K.); (R.G.A.); (L.Y.); (J.C.D.); (D.D.J.)
| | - Robel G. Alemu
- Bluestone Center for Clinical Research, Department of Oral and Maxillofacial Surgery, New York University (NYU) College of Dentistry, New York, NY 10010, USA; (N.H.T.); (K.I.); (E.C.); (C.M.S.); (N.N.S.); (H.D.T.); (D.H.K.); (R.G.A.); (L.Y.); (J.C.D.); (D.D.J.)
| | - Lei Yang
- Bluestone Center for Clinical Research, Department of Oral and Maxillofacial Surgery, New York University (NYU) College of Dentistry, New York, NY 10010, USA; (N.H.T.); (K.I.); (E.C.); (C.M.S.); (N.N.S.); (H.D.T.); (D.H.K.); (R.G.A.); (L.Y.); (J.C.D.); (D.D.J.)
| | - John C. Dolan
- Bluestone Center for Clinical Research, Department of Oral and Maxillofacial Surgery, New York University (NYU) College of Dentistry, New York, NY 10010, USA; (N.H.T.); (K.I.); (E.C.); (C.M.S.); (N.N.S.); (H.D.T.); (D.H.K.); (R.G.A.); (L.Y.); (J.C.D.); (D.D.J.)
| | - Cheng Z. Liu
- Pathology Department, New York University (NYU) Langone Health, New York, NY 10016, USA;
| | - Malvin N. Janal
- Department of Epidemiology and Health Promotion, New York University (NYU) College of Dentistry, New York, NY 10010, USA;
| | - Rocco Latorre
- Department of Molecular Pathobiology, New York University (NYU) College of Dentistry, New York, NY 10010, USA; (R.L.); (N.W.B.)
| | - Dane D. Jensen
- Bluestone Center for Clinical Research, Department of Oral and Maxillofacial Surgery, New York University (NYU) College of Dentistry, New York, NY 10010, USA; (N.H.T.); (K.I.); (E.C.); (C.M.S.); (N.N.S.); (H.D.T.); (D.H.K.); (R.G.A.); (L.Y.); (J.C.D.); (D.D.J.)
- Department of Molecular Pathobiology, New York University (NYU) College of Dentistry, New York, NY 10010, USA; (R.L.); (N.W.B.)
| | - Nigel W. Bunnett
- Department of Molecular Pathobiology, New York University (NYU) College of Dentistry, New York, NY 10010, USA; (R.L.); (N.W.B.)
- Department of Neuroscience and Physiology, Neuroscience Institute, New York University (NYU) Langone Health, New York, NY 10016, USA
| | - Laura E. Edgington-Mitchell
- Bluestone Center for Clinical Research, Department of Oral and Maxillofacial Surgery, New York University (NYU) College of Dentistry, New York, NY 10010, USA; (N.H.T.); (K.I.); (E.C.); (C.M.S.); (N.N.S.); (H.D.T.); (D.H.K.); (R.G.A.); (L.Y.); (J.C.D.); (D.D.J.)
- Department of Biochemistry and Pharmacology, Bio21 Institute, University of Melbourne, Parkville, VIC 3052, Australia;
- Drug Discovery Biology, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, VIC 3052, Australia
| | - Brian L. Schmidt
- Bluestone Center for Clinical Research, Department of Oral and Maxillofacial Surgery, New York University (NYU) College of Dentistry, New York, NY 10010, USA; (N.H.T.); (K.I.); (E.C.); (C.M.S.); (N.N.S.); (H.D.T.); (D.H.K.); (R.G.A.); (L.Y.); (J.C.D.); (D.D.J.)
- Department of Neuroscience and Physiology, Neuroscience Institute, New York University (NYU) Langone Health, New York, NY 10016, USA
| |
Collapse
|
24
|
Heussner MJ, Folger JK, Dias C, Massri N, Dahdah A, Vermeer PD, Laumet G. A Novel Syngeneic Immunocompetent Mouse Model of Head and Neck Cancer Pain Independent of Interleukin-1 Signaling. Anesth Analg 2021; 132:1156-1163. [PMID: 33323783 PMCID: PMC7969384 DOI: 10.1213/ane.0000000000005302] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Pain is one of the first presenting symptoms in patients with head and neck cancer, who often develop chronic and debilitating pain as the disease progresses. Pain is also an important prognostic marker for survival. Unfortunately, patients rarely receive effective pain treatment due to our limited knowledge of the mechanisms underlying head and neck cancer pain (HNCP). Pain is often associated with neuroinflammation and particularly interleukin (IL)-1 signaling. The purpose of this study is to develop a novel syngeneic model of HNCP in immunocompetent mice to examine the contribution of IL-1 signaling. METHODS Male C57BL/6 mice were injected with a murine model of human papillomavirus (HPV+)-induced oropharyngeal squamous cell carcinoma in their right hindlimb to induce tumor growth. Pain sensitivity was measured via von Frey filaments. Spontaneous pain was assessed via the facial grimace scale. IL-1β was measured by quantifying gene expression via quantitative polymerase chain reaction (qPCR) and enzyme-linked immunosorbent assay (ELISA). RESULTS Pain hypersensitivity and spontaneous pain develop quickly after the implantation of tumor cells, a time when tumor volume is still insignificant. Spinal and circulating IL-1β levels are significantly elevated in tumor-bearing mice. Blocking IL-1 signaling either by intrathecal administration of interleukin-1 receptor antagonist (IL-1ra) or by genetic deletion (interleukin-1 receptor knockout [Il1r1-/-]) does not alleviate HNCP. CONCLUSIONS We established the first syngeneic model of HNCP in immunocompetent mice. Unlike inflammatory or nerve-injured pain, HNCP is independent of IL-1 signaling. These findings challenge the common belief that pain results from tissue compression or IL-1 signaling in patients with head and neck cancer.
Collapse
Affiliation(s)
- Matthew J. Heussner
- Department of Physiology, Michigan State University, East Lansing, MI 48824, USA
- College of Osteopathic Medicine, Michigan State University, East Lansing, MI 48824, USA
| | - Joseph K. Folger
- Department of Physiology, Michigan State University, East Lansing, MI 48824, USA
| | - Christina Dias
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Noura Massri
- Department of Physiology, Michigan State University, East Lansing, MI 48824, USA
| | - Albert Dahdah
- Department of Microbiology & Molecular Genetics, Michigan State University, East Lansing, MI 48824, USA
| | - Paola D. Vermeer
- Cancer Biology and Immunotherapies Group, Sanford Research, Sioux Falls, SD 57104, USA
| | - Geoffroy Laumet
- Department of Physiology, Michigan State University, East Lansing, MI 48824, USA
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| |
Collapse
|
25
|
Peripheral nerve injury and sensitization underlie pain associated with oral cancer perineural invasion. Pain 2021; 161:2592-2602. [PMID: 32658150 DOI: 10.1097/j.pain.0000000000001986] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Cancer invading into nerves, termed perineural invasion (PNI), is associated with pain. Here, we show that oral cancer patients with PNI report greater spontaneous pain and mechanical allodynia compared with patients without PNI, suggesting that unique mechanisms drive PNI-induced pain. We studied the impact of PNI on peripheral nerve physiology and anatomy using a murine sciatic nerve PNI model. Mice with PNI exhibited spontaneous nociception and mechanical allodynia. Perineural invasion induced afterdischarge in A high-threshold mechanoreceptors (HTMRs), mechanical sensitization (ie, decreased mechanical thresholds) in both A and C HTMRs, and mechanical desensitization in low-threshold mechanoreceptors. Perineural invasion resulted in nerve damage, including axon loss, myelin damage, and axon degeneration. Electrophysiological evidence of nerve injury included decreased conduction velocity, and increased percentage of both mechanically insensitive and electrically unexcitable neurons. We conclude that PNI-induced pain is driven by nerve injury and peripheral sensitization in HTMRs.
Collapse
|
26
|
TNFα promotes oral cancer growth, pain, and Schwann cell activation. Sci Rep 2021; 11:1840. [PMID: 33469141 PMCID: PMC7815837 DOI: 10.1038/s41598-021-81500-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 01/07/2021] [Indexed: 12/11/2022] Open
Abstract
Oral cancer is very painful and impairs a patient's ability to eat, talk, and drink. Mediators secreted from oral cancer can excite and sensitize sensory neurons inducing pain. Cancer mediators can also activate Schwann cells, the peripheral glia that regulates neuronal function and repair. The contribution of Schwann cells to oral cancer pain is unclear. We hypothesize that the oral cancer mediator TNFα activates Schwann cells, which further promotes cancer progression and pain. We demonstrate that TNFα is overexpressed in human oral cancer tissues and correlates with increased self-reported pain in patients. Antagonizing TNFα reduces oral cancer proliferation, cytokine production, and nociception in mice with oral cancer. Oral cancer or TNFα alone increases Schwann cell activation (measured by Schwann cell proliferation, migration, and activation markers), which can be inhibited by neutralizing TNFα. Cancer- or TNFα-activated Schwann cells release pro-nociceptive mediators such as TNFα and nerve growth factor (NGF). Activated Schwann cells induce nociceptive behaviors in mice, which is alleviated by blocking TNFα. Our study suggests that TNFα promotes cancer proliferation, progression, and nociception at least partially by activating Schwann cells. Inhibiting TNFα or Schwann cell activation might serve as therapeutic approaches for the treatment of oral cancer and associated pain.
Collapse
|
27
|
Schaller AKCS, Peterson A, Bäckryd E. Pain management in patients undergoing radiation therapy for head and neck cancer - a descriptive study. Scand J Pain 2020; 21:256-265. [PMID: 34387952 DOI: 10.1515/sjpain-2020-0067] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 10/16/2020] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Patients with head and neck cancer (HNC) experience serious pain related to tumour, surgery, chemotherapy, and radiotherapy treatment (RT). Oral mucositis, a painful complication of RT, may require opioid analgesics to control pain.This longitudinal study, during RT but also four weeks post-RT, examines the relationships between oral mucositis, pain, and opioid doses in in HNC patients. The aim was to evaluate the clinical effectiveness of an opioid treatment strategy. METHODS Sixty-three patients with HNC undergoing radiotherapy answered self-reported questionnaires on pain intensity on a 0-10 numerical rating scale (NRS) three times a week. Oral mucositis signs were evaluated using the WHO mucositis index score, ranging from 0 (normal) to 4 (severe), and pharmacological treatment with opioids was registered prospectively once a week. All data were related to given radiation dose, and all outcome measures at each time point therefore relate to the same radiation dose (i.e., not to when the patient was included in the study). RESULTS Opioids were used by 78% of the patients. Most of the patients experienced only mild pain (NRS 0-4), although the majority developed mucositis grade 2-4 according to WHO mucositis index. Function-related pain intensity and opioid doses were highest during the sixth week of RT, with 3.67 (0-9) in NRS and 84 (0-430) mg oral morphine equivalents per day (median, range). At that same time point, significant positive correlations were found between the grade of mucositis and pain intensities. Patients with mucositis grade 2-4 were investigated further; in this subgroup, we found that opioid doses did not differ between patients with mild pain and patients with moderate to severe pain. Our multivariate data analysis defined a cluster of patients characterized by the presence of mucositis, cancer site in pharynx, concomitant chemotherapy, and the absence of surgery. CONCLUSIONS In HNC patients who were followed closely by pain care personnel during and after RT, pain was often satisfactorily alleviated with a structured use of opioids, including stepwise increases of fentanyl patches and oral morphine as needed. However, some patients with oral mucositis grade 2-4 experienced severe pain. Strong opioids, i.e. the third step of the WHO pain ladder, remain the mainstay of analgesic therapy in treating moderate to severe cancer-related pain, including patients with HNC. This real-life study indicates that RT-related pain is not a fatality. A proactive stance, monitoring these patients closely and regularly, is probably crucial in order to achieve good treatment results. Further studies are needed to develop better pain treatment strategies for those patients who develop severe oral mucositis-related pain despite intensive opioid treatment.
Collapse
Affiliation(s)
- Anne K C Söderlund Schaller
- Department of Health, Medicine and Caring Sciences, Pain and Rehabilitation Center, Linköping University, Linköping, Sweden
| | - Anna Peterson
- Pain and Rehabilitation Center, University Hospital, Linköping, Sweden
| | - Emmanuel Bäckryd
- Department of Health, Medicine and Caring Sciences, Pain and Rehabilitation Center, Linköping University, Linköping, Sweden
| |
Collapse
|
28
|
Legumain Induces Oral Cancer Pain by Biased Agonism of Protease-Activated Receptor-2. J Neurosci 2020; 41:193-210. [PMID: 33172978 DOI: 10.1523/jneurosci.1211-20.2020] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 10/22/2020] [Accepted: 10/23/2020] [Indexed: 02/07/2023] Open
Abstract
Oral squamous cell carcinoma (OSCC) is one of the most painful cancers, which interferes with orofacial function including talking and eating. We report that legumain (Lgmn) cleaves protease-activated receptor-2 (PAR2) in the acidic OSCC microenvironment to cause pain. Lgmn is a cysteine protease of late endosomes and lysosomes that can be secreted; it exhibits maximal activity in acidic environments. The role of Lgmn in PAR2-dependent cancer pain is unknown. We studied Lgmn activation in human oral cancers and oral cancer mouse models. Lgmn was activated in OSCC patient tumors, compared with matched normal oral tissue. After intraplantar, facial or lingual injection, Lgmn evoked nociception in wild-type (WT) female mice but not in female mice lacking PAR2 in NaV1.8-positive neurons (Par2Nav1.8), nor in female mice treated with a Lgmn inhibitor, LI-1. Inoculation of an OSCC cell line caused mechanical and thermal hyperalgesia that was reversed by LI-1. Par2Nav1.8 and Lgmn deletion attenuated mechanical allodynia in female mice with carcinogen-induced OSCC. Lgmn caused PAR2-dependent hyperexcitability of trigeminal neurons from WT female mice. Par2 deletion, LI-1, and inhibitors of adenylyl cyclase or protein kinase A (PKA) prevented the effects of Lgmn. Under acidified conditions, Lgmn cleaved within the extracellular N terminus of PAR2 at Asn30↓Arg31, proximal to the canonical trypsin activation site. Lgmn activated PAR2 by biased mechanisms in HEK293 cells to induce Ca2+ mobilization, cAMP formation, and PKA/protein kinase D (PKD) activation, but not β-arrestin recruitment or PAR2 endocytosis. Thus, in the acidified OSCC microenvironment, Lgmn activates PAR2 by biased mechanisms that evoke cancer pain.SIGNIFICANCE STATEMENT Oral squamous cell carcinoma (OSCC) is one of the most painful cancers. We report that legumain (Lgmn), which exhibits maximal activity in acidic environments, cleaves protease-activated receptor-2 (PAR2) on neurons to produce OSCC pain. Active Lgmn was elevated in OSCC patient tumors, compared with matched normal oral tissue. Lgmn evokes pain-like behavior through PAR2 Exposure of pain-sensing neurons to Lgmn decreased the current required to generate an action potential through PAR2 Inhibitors of adenylyl cyclase and protein kinase A (PKA) prevented the effects of Lgmn. Lgmn activated PAR2 to induce calcium mobilization, cAMP formation, and activation of protein kinase D (PKD) and PKA, but not β-arrestin recruitment or PAR2 endocytosis. Thus, Lgmn is a biased agonist of PAR2 that evokes cancer pain.
Collapse
|
29
|
Naik K, Janal MN, Chen J, Bandary D, Brar B, Zhang S, Dolan JC, Schmidt BL, Albertson DG, Bhattacharya A. The Histopathology of Oral Cancer Pain in a Mouse Model and a Human Cohort. J Dent Res 2020; 100:194-200. [PMID: 33030108 DOI: 10.1177/0022034520961020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Oral cancer patients often have severe, chronic, and mechanically induced pain at the site of the primary cancer. Oral cancer pain is initiated and maintained in the cancer microenvironment and attributed to release of mediators that sensitize primary sensory nerves. This study was designed to investigate the histopathology associated with painful oral cancers in a preclinical model. The relationship of pain scores with pathologic variables was also investigated in a cohort of 72 oral cancer patients. Wild-type mice were exposed to the carcinogen, 4-nitroquinoline 1-oxide (4NQO). Nociceptive (pain) behavior was measured with the dolognawmeter, an operant device and assay for measuring functional and mechanical allodynia. Lesions developed on the tongues and esophagi of the 4NQO-treated animals and included hyperkeratoses, papillomas, dysplasias, and cancers. Papillomas included lesions with benign and dysplastic pathological features. Two histologic subtypes of squamous cell carcinomas (SCCs) were identified-SCCs with exophytic and invasive components associated with papillary lesions (pSCCs) and invasive SCCs without exophytic histology (iSCCs). Only the pSCC subtype of tongue cancer was associated with nociceptive behavior. Increased tumor size was associated with greater nociceptive behavior in the mouse model and more pain experienced by oral cancer patients. In addition, depth of invasion was associated with patient-reported pain. The pSCC histology identifies 4NQO-induced tongue cancers that are expected to be enriched for expression and release of nociceptive mediators.
Collapse
Affiliation(s)
- K Naik
- Department of Oral and Maxillofacial Surgery, New York University College of Dentistry, New York, NY, USA
| | - M N Janal
- Department of Epidemiology and Health Promotion, New York University College of Dentistry, New York, NY, USA
| | - J Chen
- New York University College of Dentistry, New York, NY, USA
| | - D Bandary
- New York University College of Dentistry, New York, NY, USA
| | - B Brar
- New York University College of Dentistry, New York, NY, USA
| | - S Zhang
- New York University College of Dentistry, New York, NY, USA
| | - J C Dolan
- Department of Oral and Maxillofacial Surgery, New York University College of Dentistry, New York, NY, USA
| | - B L Schmidt
- Department of Oral and Maxillofacial Surgery, New York University College of Dentistry, New York, NY, USA
| | - D G Albertson
- Department of Oral and Maxillofacial Surgery, New York University College of Dentistry, New York, NY, USA
| | - A Bhattacharya
- Department of Oral and Maxillofacial Surgery, New York University College of Dentistry, New York, NY, USA
| |
Collapse
|
30
|
Bhattacharya A, Janal MN, Veeramachaneni R, Dolgalev I, Dubeykovskaya Z, Tu NH, Kim H, Zhang S, Wu AK, Hagiwara M, Kerr AR, DeLacure MD, Schmidt BL, Albertson DG. Oncogenes overexpressed in metastatic oral cancers from patients with pain: potential pain mediators released in exosomes. Sci Rep 2020; 10:14724. [PMID: 32895418 PMCID: PMC7477576 DOI: 10.1038/s41598-020-71298-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 08/10/2020] [Indexed: 12/11/2022] Open
Abstract
Oral cancer patients experience pain at the site of the primary cancer. Patients with metastatic oral cancers report greater pain. Lack of pain identifies patients at low risk of metastasis with sensitivity = 0.94 and negative predictive value = 0.89. In the same cohort, sensitivity and negative predictive value of depth of invasion, currently the best predictor, were 0.95 and 0.92, respectively. Cancer pain is attributed to cancer-derived mediators that sensitize neurons and is associated with increased neuronal density. We hypothesized that pain mediators would be overexpressed in metastatic cancers from patients reporting high pain. We identified 40 genes overexpressed in metastatic cancers from patients reporting high pain (n = 5) compared to N0 cancers (n = 10) and normal tissue (n = 5). The genes are enriched for functions in extracellular matrix organization and angiogenesis. They have oncogenic and neuronal functions and are reported in exosomes. Hierarchical clustering according to expression of neurotrophic and axon guidance genes also separated cancers according to pain and nodal status. Depletion of exosomes from cancer cell line supernatant reduced nociceptive behavior in a paw withdrawal assay, supporting a role for exosomes in cancer pain. The identified genes and exosomes are potential therapeutic targets for stopping cancer and attenuating pain.
Collapse
Affiliation(s)
- Aditi Bhattacharya
- Bluestone Center for Clinical Research, New York University College of Dentistry, 421 First Avenue, Room 233W, New York, NY, 10010, USA.,Department of Oral and Maxillofacial Surgery, New York University College of Dentistry, New York, NY, 10010, USA
| | - Malvin N Janal
- Department of Epidemiology and Health Promotion, New York University College of Dentistry, New York, NY, 10010, USA
| | - Ratna Veeramachaneni
- Bluestone Center for Clinical Research, New York University College of Dentistry, 421 First Avenue, Room 233W, New York, NY, 10010, USA.,Department of Oral and Maxillofacial Surgery, New York University College of Dentistry, New York, NY, 10010, USA
| | - Igor Dolgalev
- Applied Bioinformatics Laboratories, New York University Langone Medical Center, New York, NY, 10016, USA
| | - Zinaida Dubeykovskaya
- Department of Oral and Maxillofacial Surgery, New York University College of Dentistry, New York, NY, 10010, USA
| | - Nguyen Huu Tu
- Department of Oral and Maxillofacial Surgery, New York University College of Dentistry, New York, NY, 10010, USA
| | - Hyesung Kim
- New York University College of Dentistry, New York, NY, 10010, USA
| | - Susanna Zhang
- New York University College of Dentistry, New York, NY, 10010, USA
| | - Angie K Wu
- Bluestone Center for Clinical Research, New York University College of Dentistry, 421 First Avenue, Room 233W, New York, NY, 10010, USA
| | - Mari Hagiwara
- Department of Radiology, New York University School of Medicine, New York, NY, 10016, USA
| | - A Ross Kerr
- Department of Oral and Maxillofacial Pathology, Radiology and Medicine, New York University, New York, NY, 10010, USA
| | - Mark D DeLacure
- Division of Head and Neck Surgery and Oncology, New York University School of Medicine, New York, NY, 10016, USA
| | - Brian L Schmidt
- Bluestone Center for Clinical Research, New York University College of Dentistry, 421 First Avenue, Room 233W, New York, NY, 10010, USA.,Department of Oral and Maxillofacial Surgery, New York University College of Dentistry, New York, NY, 10010, USA
| | - Donna G Albertson
- Bluestone Center for Clinical Research, New York University College of Dentistry, 421 First Avenue, Room 233W, New York, NY, 10010, USA. .,Department of Oral and Maxillofacial Surgery, New York University College of Dentistry, New York, NY, 10010, USA.
| |
Collapse
|
31
|
Khare R, Yasir M, Singh P, Shrivastava R. Diagnostic aids for early detection of oral squamous cell carcinoma: concepts and emerging techniques. MINERVA BIOTECNOL 2020. [DOI: 10.23736/s1120-4826.19.02586-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
32
|
Söderlund Schaller A, Dragioti E, Liedberg GM, Larsson B. Are patient education and self-care advantageous for patients with head and neck cancer? A feasibility study. Nurs Open 2019; 6:1528-1541. [PMID: 31660181 PMCID: PMC6805323 DOI: 10.1002/nop2.361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 06/19/2019] [Accepted: 07/10/2019] [Indexed: 01/01/2023] Open
Abstract
AIM This study evaluates whether patient education and individually self-care reduces pain and improves QoL, mood and sleep during and after radiotherapy treatment for patients with head and neck cancer. DESIGN A longitudinal, two-armed feasibility study design was performed. METHODS Sixty-four participants with curative intent were included in the study. All participants answered questions about pain three times a week and completed a survey questionnaire about pain, QoL, psychological aspects and barriers towards pain management at baseline, at 4 weeks and at 10 weeks. Thirty-four of the participants attended in two education sessions on pain based on their beliefs about pain and received individualized self-care instructions based on their weekly rating of pain. RESULT This study did not find any significant group differences for the pain, QoL, mood and sleep.
Collapse
Affiliation(s)
- Anne Söderlund Schaller
- Pain and Rehabilitation Centre and Department of Medical and Health SciencesLinköping UniversityLinköpingSweden
| | - Elena Dragioti
- Pain and Rehabilitation Centre and Department of Medical and Health SciencesLinköping UniversityLinköpingSweden
| | - Gunilla M. Liedberg
- Division of Occupational Therapy, Department of Social and Welfare StudiesFaculty of Health Sciences, Campus Norrkoping, Linköping UniversityLinköpingSweden
| | - Britt Larsson
- Pain and Rehabilitation Centre and Department of Medical and Health SciencesLinköping UniversityLinköpingSweden
| |
Collapse
|
33
|
Epstein JB, Miaskowski C. Oral Pain in the Cancer Patient. J Natl Cancer Inst Monogr 2019; 2019:5551353. [DOI: 10.1093/jncimonographs/lgz003] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 02/07/2019] [Accepted: 04/01/2019] [Indexed: 01/02/2023] Open
Abstract
Abstract
Oral pain due to cancer and associated treatments is common. The prevalence and severity of oral cancer is high. Painful oral mucositis develops in head and neck cancer patients following surgery and associated radiation therapy and/or chemotherapy. In addition, oral pain, including pain from mucositis, occurs in patients receiving chemotherapy for cancers of the hematopoietic system and cancers at other anatomic sites. Despite pain management practices that include high-dose opioid analgesics, patients rarely obtain relief from either head and neck cancer pain or mucositis pain. Because oral pain in cancer patients is likely due to both nociceptive and neuropathic mechanisms, effective management of pain requires treatments for both processes. As knowledge of the pathophysiology of oral pain in cancer patients increases, new approaches for the prevention and management are anticipated. This article focuses on the emerging evidence that supports the molecular mechanisms and the unique oral micro-neuroanatomy that in combination produce the severe oral pain experienced by cancer patients. In addition, this article summarizes the current state of clinical management of oral mucositis pain.
Collapse
Affiliation(s)
- Joel B Epstein
- Department of Surgery, City of Hope, Duarte, CA
- Department of Surgery, Cedars-Sinai Health System, Los Angeles, CA
- Seattle Cancer Care Alliance, Seattle, WA
| | - Christine Miaskowski
- Department of Physiological Nursing, University of California San Francisco, San Francisco, CA
| |
Collapse
|
34
|
Grayson M, Furr A, Ruparel S. Depiction of Oral Tumor-Induced Trigeminal Afferent Responses Using Single-Fiber Electrophysiology. Sci Rep 2019; 9:4574. [PMID: 30872649 PMCID: PMC6418205 DOI: 10.1038/s41598-019-39824-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 01/22/2019] [Indexed: 02/02/2023] Open
Abstract
Considerable gap in knowledge exists about the mechanisms by which oral tumors regulate peripheral sensory fibers to produce pain and altered sensations. To address this gap, we used a murine model of oral squamous cell carcinoma (OSCC) of the tongue to investigate changes in response properties of trigeminal afferent neurons. Using this model, we developed an ex vivo method for single neuron recordings of the lingual nerve from isolated tongue tissue. Our data demonstrated that the tongue tumor produced increased spontaneous firing of lingual fibers compared to control as well as produced mechanical hypersensitivity and reduced von Frey thresholds of C- and A-slow-high-threshold mechanoreceptors (HTMR) fibers but had no effect on C-LTMR, A-slow-LTMR and A-fast lingual fibers. Mechanically-insensitive fibers were also detected in lingual afferents of the control group, that were significantly decreased in tumor-bearing preparations. Collectively, using single fiber electrophysiology of lingual sensory fibers, we show that human OSCC tumors sensitize peripheral trigeminal nerve terminals, providing a unique opportunity to study mechanisms of oral cancer pain.
Collapse
Affiliation(s)
- Max Grayson
- Department of Endodontics, University of Texas Health at San Antonio, San Antonio, TX, USA
| | - Ashley Furr
- Department of Endodontics, University of Texas Health at San Antonio, San Antonio, TX, USA
| | - Shivani Ruparel
- Department of Endodontics, University of Texas Health at San Antonio, San Antonio, TX, USA.
| |
Collapse
|
35
|
Kopruszinski CM, dos Reis RC, Rae GA, Chichorro JG. Blockade of peripheral endothelin receptors abolishes heat hyperalgesia and spontaneous nociceptive behavior in a rat model of facial cancer. Arch Oral Biol 2019; 97:231-237. [DOI: 10.1016/j.archoralbio.2018.10.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 10/30/2018] [Accepted: 10/31/2018] [Indexed: 12/27/2022]
|
36
|
Scheff NN, Bhattacharya A, Dowse E, Dang RX, Dolan JC, Wang S, Kim H, Albertson DG, Schmidt BL. Neutrophil-Mediated Endogenous Analgesia Contributes to Sex Differences in Oral Cancer Pain. Front Integr Neurosci 2018; 12:52. [PMID: 30405367 PMCID: PMC6204375 DOI: 10.3389/fnint.2018.00052] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 10/01/2018] [Indexed: 01/14/2023] Open
Abstract
The incidence of oral cancer in the United States is increasing, especially in young people and women. Patients with oral cancer report severe functional pain. Using a patient cohort accrued through the New York University Oral Cancer Center and immune-competent mouse models, we identify a sex difference in the prevalence and severity of oral cancer pain. A neutrophil-mediated endogenous analgesic mechanism is present in male mice with oral cancer. Local naloxone treatment potentiates cancer mediator-induced orofacial nociceptive behavior in male mice only. Tongues from male mice with oral cancer have significantly more infiltrating neutrophils compared to female mice with oral cancer. Neutrophils isolated from the cancer-induced inflammatory microenvironment express beta-endorphin and met-enkephalin. Furthermore, neutrophil depletion results in nociceptive behavior in male mice. These data suggest a role for sex-specific, immune cell-mediated endogenous analgesia in the treatment of oral cancer pain.
Collapse
Affiliation(s)
- Nicole N Scheff
- Bluestone Center for Clinical Research, New York University, New York, NY, United States
| | - Aditi Bhattacharya
- Bluestone Center for Clinical Research, New York University, New York, NY, United States
| | - Edward Dowse
- College of Dentistry, New York University, New York, NY, United States
| | - Richard X Dang
- College of Dentistry, New York University, New York, NY, United States
| | - John C Dolan
- Bluestone Center for Clinical Research, New York University, New York, NY, United States
| | - Susanna Wang
- College of Dentistry, New York University, New York, NY, United States
| | - Hyesung Kim
- Bluestone Center for Clinical Research, New York University, New York, NY, United States
| | - Donna G Albertson
- Bluestone Center for Clinical Research, New York University, New York, NY, United States
| | - Brian L Schmidt
- Bluestone Center for Clinical Research, New York University, New York, NY, United States
| |
Collapse
|
37
|
Le A, Palamar JJ. Oral health implications of increased cannabis use among older adults: Another public health concern? JOURNAL OF SUBSTANCE USE 2018; 24:61-65. [PMID: 30524195 PMCID: PMC6277025 DOI: 10.1080/14659891.2018.1508518] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 07/29/2018] [Indexed: 12/29/2022]
Abstract
Prevalence of cannabis use among older Americans (aged ≥ 65) appears to be rising, and emerging evidence associates cannabis use with several oral diseases. The burden of oral diseases among older Americans is great, but literature discussing potential implications of increasing rates of cannabis use and the oral health of older persons is lacking. This paper explores the latest trends in prevalence of cannabis use among older Americans and summarizes the literature on the oral health status of older adults and oral effects of cannabis use, and considers broad implications for oral health and public health policy and future research. Further studies on the effects cannabis use on the oral health of older adults are needed. Future research should investigate older subjects' susceptibility to cannabis-related oral diseases, as well as the proportions that develop disease. Policymakers may wish to tackle barriers to access of dental services for the older population, or target subsets of the population that suffer from comparably higher rates of oral diseases, while dental professionals may require training on managing underlying substance use behaviors in addition to clinical oral manifestations.
Collapse
Affiliation(s)
- Austin Le
- Department of Population Health, New York University Langone Medical Center, New York, USA
- New York University College of Dentistry, New York, USA
| | - Joseph J. Palamar
- Department of Population Health, New York University Langone Medical Center, New York, USA
| |
Collapse
|
38
|
Qin SH, Li XM, Li WL. [Systematic retrospective study of oral cancer-related quality of life scale]. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2018; 36:410-420. [PMID: 30182570 PMCID: PMC7048259 DOI: 10.7518/hxkq.2018.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 06/09/2018] [Indexed: 01/26/2023]
Abstract
OBJECTIVE The quality of life (QOL) related to oral cancer has recently become a focus of clinical studies. This study aims to systematically review the current research situation of QOL of local and foreign oral cancer patients and explore the existing related problems and future research directions to provide references and solutions. METHODS Through relevant key words, PubMed, Wiley InterScience, Science Direct, CNKI, and Wanfang databases were first searched. The related target literature from 2000 to 2017 were screened. Finally, the frequency of oral cancer related to QOL scale used in literature was calculated, and the related scales were briefly introduced. RESULTS From the target literature, 218 English target literature, 55 Chinese target literature, 24 English scales, and 12 Chinese scales were selected. The most widely used scales for assessing the QOL of patients with oral cancer were as follows: University of Washington Quality of Life Questionnaire (UW-QOL), European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30/Head and Neck 35 (EORTC QLQ-C30/H&N35), 36-Item Short-Form Health Survey (SF-36), Functional Assessment of Cancer Therapy-Head and Neck (FACT-H&N), and Oral Health Impact Profile (OHIP). CONCLUSIONS The QOL related to oral cancer was well underway, and the study of geographical distribution was widespread. However, the work on self-developed scale remains inadequate. UW-QOL, EORTC QLQ-C30/H&N35, and FACT-H&N can be utilized as the preferred scales for evaluating the QOL of oral cancer patients. A specific disease-related function scale can also be selected according to specific research objectives.
Collapse
Affiliation(s)
- Shuai-Hua Qin
- Dept. of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Xin-Ming Li
- Dept. of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Wen-Lu Li
- Dept. of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| |
Collapse
|
39
|
miRNAs: Important Targets for Oral Cancer Pain Research. BIOMED RESEARCH INTERNATIONAL 2017; 2017:4043516. [PMID: 29214166 PMCID: PMC5682905 DOI: 10.1155/2017/4043516] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 08/28/2017] [Accepted: 09/14/2017] [Indexed: 02/07/2023]
Abstract
Pain is a symptom shared by an incredible number of diseases. It is also one of the primary conditions that prompt individuals to seek medical treatment. Head and neck squamous cell carcinoma (HNSCC) corresponds to a heterogeneous disease that may arise from many distinct structures of a large, highly complex, and intricate region. HNSCC affects a great number of patients worldwide and is directly associated with chronic pain, which is especially prominent during the advanced stages of oral squamous cell carcinoma (OSCC), an anatomical and clinical subtype that corresponds to the great majority oral cancers. Although the cellular and molecular bases of oral cancer pain have not been fully established yet, the results of recent studies suggest that different epigenetic mechanisms may contribute to this process. For instance, there is strong scientific evidence that microRNAs (miRNAs), small RNA molecules that do not encode proteins, might act by regulating the mechanisms underlying cancer-related pain. Among the miRNAs that could possibly interfere in pain-signaling pathways, miR-125b, miR-181, and miR-339 emerge as some of the most promising candidates. In fact, such molecules apparently contribute to inflammatory pain. Moreover, these molecules possibly influence the activity of endogenous pain control systems (e.g., opioidergic and serotonergic systems), which could ultimately result in peripheral and central sensitization, central nervous system (CNS) phenomena innately associated with chronic pain. This review paper focuses on the current scientific knowledge regarding the involvement of miRNAs in cancer pain, with special attention dedicated to OSCC-related pain.
Collapse
|
40
|
Lalla RV, Treister N, Sollecito T, Schmidt B, Patton LL, Mohammadi K, Hodges JS, Brennan MT. Oral complications at 6 months after radiation therapy for head and neck cancer. Oral Dis 2017; 23:1134-1143. [PMID: 28675770 DOI: 10.1111/odi.12710] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 05/25/2017] [Accepted: 06/19/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To examine oral complications 6 months after modern radiation therapy (RT) for head and neck cancer (HNC). METHODS Prospective multicenter cohort study of patients with HNC receiving intensity-modulated radiation therapy or more advanced RT. Stimulated whole salivary flow, maximal mouth opening, oral mucositis, oral pain, oral health-related quality of life (OH-QOL), and oral hygiene practices were measured in 372 subjects pre-RT and 216 subjects at 6 months from the start of RT. RESULTS Mean stimulated whole salivary flow declined from 1.09 to 0.47 ml/min at 6 months (p < .0001). Mean maximal mouth opening reduced from 45.58 to 42.53 mm at 6 months (p < .0001). 8.1% of subjects had some oral mucositis at 6 months, including 3.8% with oral ulceration. Mean overall pain score was unchanged. OH-QOL was reduced at 6 months, with changes related to dry mouth, sticky saliva, swallowing solid foods, and sense of taste (p ≤ .0001). At 6 months, there was greater frequency of using dental floss and greater proportion using supplemental fluoride (p < .0001). CONCLUSIONS Despite advances in RT techniques, patients with HNC experience oral complications 6 months after RT, with resulting negative impacts on oral function and quality of life.
Collapse
Affiliation(s)
- R V Lalla
- Section of Oral Medicine, MC1605, University of Connecticut Health, Farmington, CT, USA
| | - N Treister
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, MA, USA.,Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
| | - T Sollecito
- Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia, PA, USA.,Division of Oral Medicine, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - B Schmidt
- Department of Oral & Maxillofacial Surgery and Bluestone Center for Clinical Research, New York University College of Dentistry, New York, NY, USA
| | - L L Patton
- Department of Dental Ecology, School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
| | - K Mohammadi
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - J S Hodges
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - M T Brennan
- Department of Oral Medicine, Carolinas Medical Center, Charlotte, NC, USA
| | | |
Collapse
|
41
|
Viet CT, Dang D, Aouizerat BE, Miaskowski C, Ye Y, Viet DT, Ono K, Schmidt BL. OPRM1 Methylation Contributes to Opioid Tolerance in Cancer Patients. THE JOURNAL OF PAIN 2017; 18:1046-1059. [PMID: 28456745 DOI: 10.1016/j.jpain.2017.04.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 03/13/2017] [Accepted: 04/01/2017] [Indexed: 11/28/2022]
Abstract
Cancer patients in pain require high doses of opioids and quickly become opioid-tolerant. Previous studies have shown that chronic cancer pain as well as high-dose opioid use lead to mu-opioid receptor downregulation. In this study we explore downregulation of the mu-opioid receptor gene (OPRM1), as a mechanism for opioid tolerance in the setting of opioid use for cancer pain. We demonstrate in a cohort of 84 cancer patients that high-dose opioid use correlates with OPRM1 hypermethylation in peripheral leukocytes of these patients. We then reverse-translate our clinical findings by creating a mouse cancer pain model; we create opioid tolerance in the mouse cancer model to mimic opioid tolerance in the cancer patients. Using this model we determine the functional significance of OPRM1 methylation on cancer pain and opioid tolerance. We focus on 2 main cells within the cancer microenvironment: the cancer cell and the neuron. We show that targeted re-expression of mu-opioid receptor on cancer cells inhibits mechanical and thermal hypersensitivity, and prevents opioid tolerance, in the mouse model. The resultant analgesia and protection against opioid tolerance are likely due to preservation of mu-opioid receptor expression on the cancer-associated neurons. PERSPECTIVE We demonstrate that epigenetic regulation of OPRM1 contributes to opioid tolerance in cancer patients, and that targeted gene therapy could treat cancer-induced nociception and opioid tolerance in a mouse cancer model.
Collapse
Affiliation(s)
- Chi T Viet
- Department of Oral Maxillofacial Surgery, New York University, New York, New York; Bluestone Center for Clinical Research, New York University, New York, New York
| | - Dongmin Dang
- Department of Oral Maxillofacial Surgery, New York University, New York, New York; Bluestone Center for Clinical Research, New York University, New York, New York
| | - Bradley E Aouizerat
- Bluestone Center for Clinical Research, New York University, New York, New York; School of Nursing, University of California, San Francisco, California; Institute for Human Genetics, University of California, San Francisco, California
| | | | - Yi Ye
- Department of Oral Maxillofacial Surgery, New York University, New York, New York; Bluestone Center for Clinical Research, New York University, New York, New York
| | - Dan T Viet
- Bluestone Center for Clinical Research, New York University, New York, New York
| | - Kentaro Ono
- Department of Oral Maxillofacial Surgery, New York University, New York, New York; Bluestone Center for Clinical Research, New York University, New York, New York
| | - Brian L Schmidt
- Department of Oral Maxillofacial Surgery, New York University, New York, New York; Bluestone Center for Clinical Research, New York University, New York, New York.
| |
Collapse
|
42
|
Yang Y, Zhang P, Li W. Comparison of orofacial pain of patients with different stages of precancer and oral cancer. Sci Rep 2017; 7:203. [PMID: 28303010 PMCID: PMC5428284 DOI: 10.1038/s41598-017-00370-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 02/21/2017] [Indexed: 12/28/2022] Open
Abstract
Orofacial pain impairs a patient's speech, swallowing, eating and interpersonal relations. Thirty-seven patients with a premalignant oral lesion, 124 patients with oral squamous cell carcinoma (OSSC), and 21 patients with a recurrence of OSSC were evaluated for their orofacial pain. The University of California San Francisco Oral Cancer Pain Questionnaire was administered to these patients at their initial visit, before they were prescribed analgesics for pain and before any treatment. Significant differences with respect to orofacial pain between the groups could be evaluatedwere observed. Patients with recurrence had the highest facial pain and patients with precancer had the lowest. Patients with OSSC and recurrence of OSSC reported significant levels of orofacial pain and functional restriction because of pain. Moreover, patients with recurrence of OSSC experienced significantly higher function-related pain, rather than pain qualities. These findings suggest that an important predictor for recurrence of OSSC may be the onset of orofacial pain that is exacerbated during function. The present study examined orofacial pain depending on the disease severity of precancer and oral cancer patients. Earlier recognition of symptoms of OSSC may improve early detection of its recurrence.
Collapse
Affiliation(s)
- Yanjie Yang
- Department of Stomatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan, 450052, China
| | - Peipei Zhang
- Department of Stomatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan, 450052, China
| | - Wenlu Li
- Department of Stomatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan, 450052, China.
| |
Collapse
|
43
|
Lalla RV, Long-Simpson L, Hodges JS, Treister N, Sollecito T, Schmidt B, Patton LL, Brennan MT. Clinical registry of dental outcomes in head and neck cancer patients (OraRad): rationale, methods, and recruitment considerations. BMC Oral Health 2017; 17:59. [PMID: 28241807 PMCID: PMC5327511 DOI: 10.1186/s12903-017-0344-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 02/08/2017] [Indexed: 01/25/2023] Open
Abstract
Background Most head and neck (H&N) cancer patients receive high-dose external beam radiation therapy (RT), often in combination with surgery and/or chemotherapy. Unfortunately, high-dose RT has significant adverse effects on the oral and maxillofacial tissues, some of which persist for the life of the patient. However, dental management of these patients is based largely on individual and expert opinion, as few studies have followed patients prospectively to determine factors that predict adverse oral sequelae. In addition, many previous studies were conducted before wide-spread adoption of intensity-modulated radiation therapy (IMRT) and concurrent chemotherapy. The objective of this multi-center study is to systematically evaluate the oral health of subjects for 2 years after commencement of RT, with the goal of identifying risk factors that predict adverse oral outcomes post-RT. Methods This is a prospective multi-center longitudinal cohort study of H&N cancer patients who receive high-dose RT with curative intent. Planned enrollment is 756 subjects at 6 primary clinical sites (and their affiliated sites) in the USA. A baseline visit is conducted prior to the beginning of RT. Follow-up visits are conducted at 6, 12, 18 and 24 months from the start of RT. The primary outcome measure is the 2-year rate of tooth loss in patients who have received at least one session of external beam RT for H&N cancer. Secondary outcome measures include the incidence of exposed intraoral bone; incidence of post-extraction complications; change in Decayed Missing and Filled Surfaces (DMFS); change in periodontal measures; change in stimulated whole salivary flow rates; change in mouth opening; topical fluoride utilization; chronic oral mucositis incidence; changes in RT-specific quality of life measures; and change in oral pain scores. Discussion This study will contribute to a better understanding of the dental complications experienced by these patients. It will also enable identification of risk factors associated with adverse outcomes such as tooth loss and osteoradionecrosis. These findings will support the development of evidence-based guidelines and inform the planning of future interventional studies, with the goal of advancing improvements in patient care and outcomes. Trial registration ClinicalTrials.gov Identifier NCT02057510, registered 5 February 2014.
Collapse
Affiliation(s)
- Rajesh V Lalla
- Section of Oral Medicine, MC1605, University of Connecticut Health, 263, Farmington Avenue, Farmington, CT, 06030-1605, USA.
| | - Leslie Long-Simpson
- Division of Biostatistics, School of Public Health, University of Minnesota, 2221 University Ave SE Suite 200, Minneapolis, MN, 55414, USA
| | - James S Hodges
- Division of Biostatistics, School of Public Health, University of Minnesota, 2221 University Ave SE Suite 200, Minneapolis, MN, 55414, USA
| | - Nathaniel Treister
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, 1620 Tremont Street, 3rd Floor, Boston, MA, 02120, USA.,Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, 188 Longwood Avenue, Boston, MA 02115, USA
| | - Thomas Sollecito
- Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, 240 South 40th Street, Philadelphia, PA, 19104, USA
| | - Brian Schmidt
- Department of Oral & Maxillofacial Surgery and Bluestone Center for Clinical Research, New York University College of Dentistry, 421 First Avenue, New York, NY, 10010, USA
| | - Lauren L Patton
- Department of Dental Ecology, School of Dentistry, University of North Carolina, Chapel Hill, NC, CB 7450, USA
| | - Michael T Brennan
- Department of Oral Medicine, Carolinas Medical Center, 1000 Blythe Blvd, Charlotte, NC, 28203, USA
| | | |
Collapse
|
44
|
Yeh CF, Li WY, Chu PY, Kao SY, Chen YW, Lee TL, Hsu YB, Yang CC, Tai SK. Pretreatment pain predicts perineural invasion in oral squamous cell carcinoma: A prospective study. Oral Oncol 2016; 61:115-9. [DOI: 10.1016/j.oraloncology.2016.07.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 07/23/2016] [Indexed: 12/18/2022]
|
45
|
Jie L, Miao W, Yang J, Le L, Pan G, Chunjie L. [In vitro investigation on the mechanism of cyclooxygenase-2 upregulation induced by spleen tyrosine kinase-nuclear factor κB signaling in cancer pain caused by oral cancer-associated macrophage]. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2016; 34:454-458. [PMID: 28326700 DOI: 10.7518/hxkq.2016.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This study explores the mechanism of cyclooxygenase-2 (COX-2) upregulation in oral cancers associated with macrophage by using molecular biology techniques and primary culture of murine macrophage. METHODS Murine macrophage was induced by macrophage colony-stimulating factor (M-CSF) and Cal27 conditional medium (CM). Purity of the macrophage was detected through CD68 immunofluorescence staining. Inhibitors of spleen tyrosine kinase (Syk) and nuclear factor κB (NFκB) were used to inhibit these pathways. In addition, real-time polymerase chain reaction and Western blot analysis were used to detect alterations in COX-2 and pathway-related proteins. RESULTS All of the induced cells specifically expressed CD68. Cal27 CM could significantly induce COX-2 expression (P<0.001). Moreover, inhibition of Syk pathway attenuated NFκB-P65 phosphorylation and reduced COX-2 expression (P<0.01), and inhibition of NFκB pathway exerted no effects on Syk phosphorylation but significantly inhibited COX-2 upregulation (P<0.01). CONCLUSIONS Syk-NFκB is responsible for COX-2 overexpression in oral cancer associated with macrophages. Targeting this pathway is possibly a new approach to control oral cancer-related pain.
.
Collapse
Affiliation(s)
- Lin Jie
- State Key Laboratory of Oral Diseases, Dept. of Dental Anesthesia, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Wang Miao
- State Key Laboratory of Oral Diseases, Dept. of Dental Anesthesia, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Ji Yang
- State Key Laboratory of Oral Diseases, Dept. of Dental Anesthesia, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Liu Le
- State Key Laboratory of Oral Diseases, Dept. of Dental Anesthesia, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Gao Pan
- State Key Laboratory of Oral Diseases, Dept. of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Li Chunjie
- State Key Laboratory of Oral Diseases, Dept. of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| |
Collapse
|
46
|
Chodroff L, Bendele M, Valenzuela V, Henry M, Ruparel S. EXPRESS: BDNF Signaling Contributes to Oral Cancer Pain in a Preclinical Orthotopic Rodent Model. Mol Pain 2016; 12:12/0/1744806916666841. [PMID: 27590070 PMCID: PMC5015823 DOI: 10.1177/1744806916666841] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The majority of patients with oral cancer report intense pain that is only partially managed by current analgesics. Thus, there is a strong need to study mechanisms as well as develop novel analgesics for oral cancer pain. Current study employed an orthotopic tongue cancer model with molecular and non-reflexive behavioral assays to determine possible mechanisms of oral cancer pain. Human oral squamous cell carcinoma cells line, HSC2, was injected into the tongue of male athymic mice and tumor growth was observed by day 6. Immunohistological analyses revealed a well-differentiated tumor with a localized immune response and pronounced sensory and sympathetic innervation and vascularization. The tumor expressed TMPRSS2, a protein previously reported with oral squamous cell carcinoma. ATF3 expression in trigeminal ganglia was not altered by tumor growth. Molecular characterization of the model demonstrated altered expression of several pain-related genes, out of which up-regulation of BDNF was most striking. Moreover, BDNF protein expression in trigeminal ganglia neurons was increased and inhibition of BDNF signaling with a tyrosine kinase B antagonist, ANA-12, reversed pain-like behaviors induced by the oral tumor. Oral squamous cell carcinoma tumor growth was also associated with a reduction in feeding, mechanical hypersensitivity in the face, as well as spontaneous pain behaviors as measured by the conditioned place preference test, all of which were reversed by analgesics. Interestingly, injection of HSC2 into the hindpaw did not reproduce this spectrum of pain behaviors; nor did injection of a colonic cancer cell line into the tongue. Taken together, this orthotopic oral cancer pain model reproduces the spectrum of pain reported by oral cancer patients, including higher order cognitive changes, and demonstrates that BDNF signaling constitutes a novel mechanism by which oral squamous cell carcinoma induces pain. Identification of the key role of tyrosine kinase B signaling in oral cancer pain may serve as a novel target for drug development.
Collapse
Affiliation(s)
- Leah Chodroff
- University of Texas Health Science Center at San Antonio
| | - Michele Bendele
- University of Texas Health Science Center at San Antonio Cancer Therapy and Research Center
| | | | - Michael Henry
- University of Texas Health Science Center At San Antonio
| | - Shivani Ruparel
- University of Texas Health Science Center at San AntonioUniversity of Texas Health Science Center at San Antonio Cancer Therapy and Research CenterUniversity of Texas Health Science Center at San AntonioUniversity of Texas Health Science Center At San Antonio
| |
Collapse
|
47
|
Dogra S, Sona C, Kumar A, Yadav PN. Epigenetic regulation of G protein coupled receptor signaling and its implications in psychiatric disorders. Int J Biochem Cell Biol 2016; 77:226-39. [PMID: 27046448 DOI: 10.1016/j.biocel.2016.03.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 03/21/2016] [Accepted: 03/22/2016] [Indexed: 12/21/2022]
Abstract
G protein-coupled receptors (GPCRs) act as a relay center through which extracellular signals, in the form of neurotransmitters or therapeutics, are converted into an intracellular response, which ultimately shapes the overall response at the tissue and behavioral level. Remarkably in similar ways, epigenetic mechanisms also modulate the expression pattern of a large number of genes in response to the dynamic environment inside and outside of the body, and consequently overall response. Emerging evidences from the pharmacogenomics and preclinical studies clearly suggest that these two distinct mechanisms criss-cross each other in several neurological disorders. At one hand such cross-talks between two distinct mechanisms make disease etiology more challenging to understand, while on the other hand if dealt appropriately, such situations might provide an opportunity to find novel druggable target and strategy for the treatment of complex diseases. In this review article, we have summarized and highlighted the main findings that tie epigenetic mechanisms to GPCR mediated signaling in the pathophysiology of central nervous system (CNS) disorders, including depression, addiction and pain.
Collapse
Affiliation(s)
- Shalini Dogra
- Division of Pharmacology, CSIR-Central Drug Research Institute, Lucknow, UP 226031, India
| | - Chandan Sona
- Division of Pharmacology, CSIR-Central Drug Research Institute, Lucknow, UP 226031, India
| | - Ajeet Kumar
- Division of Pharmacology, CSIR-Central Drug Research Institute, Lucknow, UP 226031, India
| | - Prem N Yadav
- Division of Pharmacology, CSIR-Central Drug Research Institute, Lucknow, UP 226031, India.
| |
Collapse
|
48
|
Schmidt BL. The Neurobiology of Cancer Pain. J Oral Maxillofac Surg 2016; 73:S132-5. [PMID: 26608142 DOI: 10.1016/j.joms.2015.04.045] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 04/09/2015] [Indexed: 12/18/2022]
Abstract
Oral cancers are often severely painful and clinically difficult to manage. Few researchers have investigated the neurobiologic factors responsible for cancer pain; however, the study of oral cancer pain might inform us about the fundamental biology of cancer. The purpose of the present report was to summarize the clinical challenges inherent in oral cancer pain management, oral cancer pain mechanisms and mediators, and the convergence of the investigation of carcinogenesis and pain.
Collapse
Affiliation(s)
- Brian L Schmidt
- Professor, Department of Oral and Maxillofacial Surgery, New York University College of Dentistry, New York, NY.
| |
Collapse
|
49
|
Evaluation of heat hyperalgesia and anxiety like-behaviors in a rat model of orofacial cancer. Neurosci Lett 2016; 619:100-5. [PMID: 26952973 DOI: 10.1016/j.neulet.2016.03.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 02/29/2016] [Accepted: 03/01/2016] [Indexed: 12/29/2022]
Abstract
Pain and anxiety are commonly experienced by cancer patients and both significantly impair their quality of life. Some authors claim that there is a relationship between pain and anxiety, while others suggest that there is not a direct association. In any case, there is indeed a consensus that anxiety impairs the pain condition beyond be under diagnosed and undertreated in cancer pain patients. Herein we investigated if rats presenting heat hyperalgesia induced by orofacial cancer cell inoculation would display anxiety-like behaviors. In addition, we evaluated if pain blockade would result in alleviation of anxiety behaviors, as well as, if blockade of anxiety would result in pain relief. Orofacial cancer was induced in male Wistar rats by inoculation of Walker-256 cells into the right vibrissal pad. Heat facial hyperalgesia was assessed on day 6 after the inoculation, and on this time point rats were submitted to the elevated plus maze and the light-dark transition tests. The influence of lidocaine and midazolam on heat hyperalgesia and anxiety-like behaviors was assessed. The peak of facial heat hyperalgesia was detected 6 days after cancer cells inoculation, and at this time point, rats exhibited increased anxiety-like behaviors. Local treatment with lidocaine (2%/50μL) caused a marked reduction of heat hyperalgesia, but failed to affect the anxiety-like behaviors, while midazolam (0.5mg/kg, i.p.) treatment failed to change the heat threshold, but induced an anxiolytic-like effect. Altogether, our data demonstrated that rats with orofacial cancer present pain- and anxiety-like behaviors, but brief heat hyperalgesia relief does not affect the anxiety-like behaviors, and vice-versa, in our experimental conditions.
Collapse
|
50
|
Changes in and predictors of pain characteristics in patients with head and neck cancer undergoing radiotherapy. Pain 2016; 156:967-979. [PMID: 25719616 DOI: 10.1097/j.pain.0000000000000142] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Pain is a common symptom in patients with head and neck cancer (HNC) that is associated with significant decrements in physical and psychological functioning. Only 4 studies have evaluated for changes in and predictors of different pain characteristics in these patients. In this longitudinal study of patients with HNC, changes in pain intensity (i.e., average pain, worst pain), pain interference with function, and pain relief were evaluated from the initiation of radiotherapy and through the following 6 months. Hierarchical linear modeling was used to evaluate for changes over time in these 4 pain characteristics, as well as to identify predictors of interindividual variability in each characteristic. Overall, pain intensity and interference with function scores were in the mild-to-moderate range, while pain relief scores were in the moderate range. The occurrence of pain, as well as scores for each pain characteristic, increased from the initiation to the completion of radiotherapy, followed by a gradual decrease to near pretreatment levels at 6 months. However, interindividual variability existed in patients' ratings of each pain characteristic. Predictors of more severe pain characteristic scores were more comorbidities, worse physical functioning, not having surgery before radiotherapy, difficulty swallowing, mouth sores, sleep disturbance, fatigue, more energy, and less social support. Patients with more depressive symptoms had better pain relief. Although some of the predictors cannot be modified (e.g., rrence of surgery), other predictors (e.g., symptoms) can be treated. Therefore, information about these predictors may result in decreased pain in patients with HNC.
Collapse
|