Exacerbation of cancer pain after administering immune checkpoint inhibitor in a patient taking opioids: A case report

Identification of a novel protein Hq023 of the hard tick Haemaphysalis qinghaiensis and preliminary evaluation of its analgesic effect in mice model

Tick saliva contains a range of critical biological molecules which could inhibit host defenses and guarantee their food supply. Hq023, a novel cDNA sequence, was cloned from a cDNA library constructed from salivary glands of partially-engorged Haemaphysalis qinghaiensis. Hq023 has an open reading frame (ORF) of 408 bp coding a protein containing 135 amino acid residues with a molecular mass of 15 kDa. Database homology showed that Hq023 protein was structurally similar to a natural toxin U33-theraphotoxin-Cg1c from the Chinese tarantula Chilobrachys guangxiensis. A recombinant protein was expressed with the novel cDNA in a prokaryotic system and its analgesic effect was evaluated in mice model. Both tail immersion and hot-plate tests uncovered an antinociceptive activity, while in the acetic acid-induced writhing test this effect was not observed. These results indicated that the novel recombinant protein Hq023 (rHq023) probably possessed a central antinociceptive activity. Finding of the novel protein might pave a new avenue for the development of tick-derived analgesics.

Lung cancer patients with positive programmed death-ligand 1 expression endure graver postoperative pain

BACKGROUND

Postoperative pain after video-assisted thoracoscopic surgery (VATS) is common in lung cancer patients, and it is unclear whether cancer itself participates in pain regulation. Programmed cell death ligand-1 (PD-L1) expressed by tumours may be analgesic. Our study aimed to detect the association between PD-L1 and acute postoperative pain.

METHODS

We reviewed patients who underwent VATS for lung cancer with tumour PD-L1 expression analysed in our centre from Jan 2017 to Jul 2020. They were divided into PD-L1 (-) group and PD-L1 (+) group and were further divided into four subgroups according to opioids for postoperative analgesia: sufentanil PD-L1 (-), sufentanil PD-L1 (+), oxycodone PD-L1 (-), and oxycodone PD-L1 (+). We compared the numeric rating scale (NRS) for the first three postoperative days at rest or cough between groups.

RESULTS

A total of 369 patients (167 in PD-L1 (-) vs. 202 in PD-L1 (+)) were included. On the first postoperative day, NRS at cough in the PD-L1 (+) patients were higher than those in the PD-L1 (-) patients (2.91 ± 1.07 vs. 2.66 ± 1.01, p = 0.018). On the third day, NRS at cough in PD-L1 (+) patients was higher (2.50 ± 1.02 vs. 2.26 ± 1.09, p = 0.043). For patients with oxycodone, NRS was higher in PD-L1 (+) than in PD-L1 (-) (p = 0.041) at cough after surgery. In contrast, those with sufentanil did not significantly differ in NRS between groups.

CONCLUSIONS

Patients with PD-L1 (+) suffered graver pain in the early postoperative period after VATS for lung cancer compared with PD-L1 (-) on tumours. Analgesia with sufentanil seemed to overcome this effect better than oxycodone.

SIGNIFICANCE

We demonstrated that patients with positive programmed cell death ligand-1 (PD-L1) on tumours suffered graver pain in the early postoperative period after video-assisted thoracoscopic surgery for lung cancer and reacted differently with opioids. It might be beneficial to adjust analgesic protocols according to tumour PD-L1 expression for individualized postoperative pain management.