“Veins that freeze like ice cream”: Illuminating thermal pain threshold changes in CIPN

Background & Aims

Chemotherapy-induced peripheral neuropathy (CIPN) is a common effect of taxane-based treatment for breast cancer (BC)1,2. It causes numbness, tingling, burning, and thermal allodynia3. There are no preventative or curative agents and few palliative treatments3. Symptoms may be so disabling that they are dose-limiting, with unclear impacts on cancer treatment efficacy3,4. CIPN measures detecting clinically meaningful change are needed but remain insufficient for treatment decision-making4. While cold and heat pain threshold (CPT; HPT) are commonly used to measure neurotoxicity5–8, there is no consensus about levels of change considered clinically meaningful. Incorporating qualitative data with quantitative measures of CPT and HPT in a mixed methods design9 may elucidate CPT and HPT change, helping to identify clinically meaningful change to guide treatment decision-making. This study uses mixed methods to better understand CPT and HPT changes following taxane-based treatment for BC.

Methods

Participants were chemotherapy-naive, free of comorbidities associated with peripheral neuropathy, and scheduled to undergo taxane-based treatment for BC (

Results

Participants were 121 people aged 50.9 ± 11.1 years. CPT T0 and T1 descriptions were NPf in 68.4% and 61.4%, NPf+Pf in 4.3% and 14.0%, Pf in 20.5% and 15.8%, and ACT in 6.8% and 8.8%, respectively. Descriptions changed significantly (p? 0.05) for NPf to NPf+Pf, NPf to Pf; NPf+Pf to NPf, NPf+Pf to Pf; and ACT to Pf. HPT T0 and T1 descriptions were NPf in 32.8% and 23.9%, NPf+Pf in 6.0% and 6.2%, Pf in 52.6% and 59.3%, and ACT in 8.6% and 10.6%, respectively. Descriptions changed significantly for NPf to NPf+Pf, NPf to Pf, NPf to ACT; NPf+Pf to NPf, NPf+Pf to Pf; Pf to ACT; ACT to Pf.There was a group by time interaction on CPT (F(1,109) = 5.0, p = 0.03), with minimal change among T0-Pf (12.7 ± 10.0 vs. 12.0 ± 9.7) and an increase among those with other descriptions (12.5 ± 9.9 vs. 16.1 ± 9.8).There was a group by time interaction on HPT (F(1,107) = 6.0, p = 0.02), with a reduction among T0-T1? (42.9 ± 3.1 vs. 41.9 ± 3.0) and minimal change among no T0-T1? (44.0 ± 2.3 vs. 44.3 ± 2.6).

Conclusions

People described CPT and HPT sensations using non-painful, painful, and intention to act to mitigate sensation descriptions, with frequent change over time. Those who described T0 CPT testing sensations as exclusively painful experienced minimal change in cold pain sensitivity compared to people who used other descriptions, who became more sensitive. Those whose HPT sensory description changed became more sensitive to heat pain compared to those whose HPT sensory description did not change, who were more sensitive to HPT, but experienced minimal change. Qualitative data collected during standardized thermal pain threshold testing protocols provides useful information characterizing change following taxane-based chemotherapy. Future mixed methods studies with more extensive qualitative assessments of sensory experience during thermal pain threshold testing would advance our understanding of clinically meaningful change following neurotoxic chemotherapy and guide decision-making.

References

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