Emerging Molecular Targets for the Management of Cancer Pain
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INSIGHT
Emerging Molecular Targets for the Management of Cancer Pain Hai-Yan Sheng1 • Yu-Qiu Zhang2
Received: 5 December 2019 / Accepted: 21 February 2020 Ó Shanghai Institutes for Biological Sciences, CAS 2020
Pain is a common symptom in cancer patients, even long after the treatment has been completed. About 39.3%– 66.4% of patients with cancer experience moderate to severe pain, especially those with advanced cancer. The experience of pain severely affects the quality of life, including eating, sleeping, thinking, working, and even continuing treatment. With the improvement of cancer treatment and the prolongation of survival time, safe and effective pain management has become a major problem encountered by many clinicians.
Current Analgesic Regimen for Cancer Pain Cancer pain management often starts with the World Health Organization (WHO) analgesic ladder, which provides a guideline for clinicians to follow in treating cancer pain syndromes. The first step on the WHO ladder is focused on over-the-counter analgesics such as nonsteroidal anti-inflammatory drugs. The second step is weak opioids, followed by stronger opioids in the third step. In the fourth step, adding interventions to cancer pain management is considered [1]. A recent paper by & Yu-Qiu Zhang [email protected] 1
2
Department of Pathophysiology, School of Basic Medical Sciences, Xinxiang Medical University, Xinxiang 453003, China State Key Laboratory of Medical Neurobiology and Ministry of Education Frontiers Center for Brain Science, Department of Translational Neuroscience, Jing’an District Centre Hospital of Shanghai, Institutes of Brain Science, Institute of Integrative Medicine, Fudan University, Shanghai 200032, China
Scarborough and Smith [2] provides an outline for the safe and effective management of cancer pain. The authors emphasize that, although opioids are the mainstay of treatment for moderate-to-severe cancer pain, several modalities of non-opioid treatment are available to these patients, including both pharmacological and non-pharmacological treatments. In addition, there are integrative therapies such as interventions, acupuncture analgesia, and adjuvant analgesics, that deserve consideration at each step in pain management [2]. Notably, antidepressants have been used as adjuvant medication in the management of cancer pain. Since pain has become a major fear and concern of cancer patients that makes them feel worried, lonely, stressed, angry, and depressed [3], relieving the pain-related negative emotions is clinically important in the improvement of their quality of life. So far, knowledge of the effects of non-opioid analgesics on severe cancer pain is still limited. However, inflammation has been recognized as one of the hallmarks of cancer and is widely involved in the initiation and persistence of pathological pain in patients. Therefore, the development of drugs targeted at novel molecules based on anti-inflammatory mechanisms is essential for treating cancer pain.
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