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Radiation-Induced Pain Syndromes

  • Jasmit BrarEmail author
  • Grant H. Chen
  • Amitabh Gulati
Chapter

Abstract

Radiation-induced pain syndromes are an unfortunate consequence of radiation therapy administered during the treatment of various malignancies. It often manifests several months to years after completion of radiotherapy, with the diagnosis complicated by concern for local cancer recurrence. Pain syndromes due to radiation can be characterized based on anatomic location and specific tissues affected. Several radiation-induced pain syndromes have been described along with proposed pathophysiological mechanisms of injury. Common risk factors include total radiation dose, fractionation schedule, and radiation field size.

Keywords

Radiotherapy Mucositis Osteoradionecrosis Chronic abdominal pain Radiation neuropathy Brachial plexopathy Lumbosacral plexopathy Chest wall pain 

References

  1. 1.
    Van den Beuken-van Everdingen MH, De Rijke JM, Kessels AG, Schouten HC, Van Kleef M, Patijn J. Prevalence of pain in patients with cancer: a systematic review of the past 40 years. Ann Oncol. 2007;18(9):1437–49.PubMedGoogle Scholar
  2. 2.
    Delaney G, Jacob S, Featherstone C, Barton M. The role of radiotherapy in cancer treatment. Cancer. 2005;104(6):1129–37.PubMedGoogle Scholar
  3. 3.
    Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. CA Cancer J Clin. 2012;62(1):10–29.PubMedGoogle Scholar
  4. 4.
    Hubenak JR, Zhang Q, Branch CD, Kronowitz SJ. Mechanisms of injury to normal tissue after radiotherapy: a review. Plast Reconstr Surg. 2014;133(1):49e.PubMedPubMedCentralGoogle Scholar
  5. 5.
    Zhao W, Diz DI, Robbins ME. Oxidative damage pathways in relation to normal tissue injury. Br J Radiology. 2007;80(1):23–31.PubMedGoogle Scholar
  6. 6.
    Rzeszowska-Wolny J, Przybyszewski WM, Widel M. Ionizing radiation-induced bystander effects, potential targets for modulation of radiotherapy. Eur J Pharmacol. 2009;625(1):156–64.PubMedGoogle Scholar
  7. 7.
    Begg AC. Can the severity of normal tissue damage after radiation therapy be predicted? PLoS Med. 2006;3(10):e440.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Wong PC, Dodd MJ, Miaskowski C, Paul SM, Bank KA, Shiba GH, Facione N. Mucositis pain induced by radiation therapy: prevalence, severity, and use of self-care behaviors. J Pain Symptom Manag. 2006;32(1):27–37.Google Scholar
  9. 9.
    Dirix P, Nuyts S, Van den Bogaert W. Radiation-induced xerostomia in patients with head and neck cancer. Cancer. 2006;107(11):2525–34.PubMedGoogle Scholar
  10. 10.
    Pico JL, Avila-Garavito A, Naccache P. Mucositis: its occurrence, consequences, and treatment in the oncology setting. Oncologist. 1998;3(6):446–51.PubMedGoogle Scholar
  11. 11.
    Cooper JS, Fu K, Marks J, Silverman S. Late effects of radiation therapy in the head and neck region. Int J Radiat Oncol Biol Phys. 1995;31(5):1141–64.PubMedGoogle Scholar
  12. 12.
    Scully C, Epstein J, Sonis S. Oral mucositis: a challenging complication of radiotherapy, chemotherapy, and radiochemotherapy: part 1, pathogenesis and prophylaxis of mucositis. Head Neck. 2003;25(12):1057–70.PubMedGoogle Scholar
  13. 13.
    Teng MS, Futran ND. Osteoradionecrosis of the mandible. Curr Opin Otolaryngol Head Neck Surg. 2005;13(4):217–21.PubMedGoogle Scholar
  14. 14.
    Yeoh A, Gibson R, Yeoh E, Bowen J, Stringer A, Giam K, Logan R, Keefe D. Radiation therapy-induced mucositis: relationships between fractionated radiation, NF-κB, COX-1, and COX-2. Cancer Treat Rev. 2006;32(8):645–51.PubMedGoogle Scholar
  15. 15.
    Classen J, Belka C, Paulsen F, Budach W, Hoffmann W, Bamberg M. Radiation-induced gastrointestinal toxicity. Pathophysiology, approaches to treatment and prophylaxis. Strahlenther Onkol. 1998;174:82–4.PubMedGoogle Scholar
  16. 16.
    Shadad AK, Sullivan FJ, Martin JD, Egan LJ. Gastrointestinal radiation injury: symptoms, risk factors and mechanisms. World J Gastroenterol. 2013;19(2):185–98.PubMedPubMedCentralGoogle Scholar
  17. 17.
    Bye A, Tropé C, Loge JH, Hjermstad M, Kaasa S. Health-related quality of life and occurrence of intestinal side effects after pelvic radiotherapy: evaluation of long-term effects of diagnosis and treatment. Acta Oncol. 2000;39(2):173–80.PubMedGoogle Scholar
  18. 18.
    Brown MR, Ramirez JD, Farquhar-Smith P. Pain in cancer survivors. Br J Pain. 2014;8(4):139–53.PubMedPubMedCentralGoogle Scholar
  19. 19.
    Levy MH, Chwistek M, Mehta RS. Management of chronic pain in cancer survivors. Cancer J. 2008;14(6):401–9.PubMedGoogle Scholar
  20. 20.
    Kolla SB, Dash A. Radiation cystitis: acute and chronic. In: Radiation therapy for pelvic malignancy and its consequences. New York: Springer; 2015. p. 111–8.Google Scholar
  21. 21.
    Parker RG, Berry HC. Late effects of therapeutic irradiation on the skeleton and bone marrow. Cancer. 1976;37(S2):1162–71.PubMedGoogle Scholar
  22. 22.
    Bluemke DA, Fishman EK, Scott WW Jr. Skeletal complications of radiation therapy. Radiographics. 1994;14(1):111–21.PubMedGoogle Scholar
  23. 23.
    Massin PH, Duparc JA. Total hip replacement in irradiated hips. A retrospective study of 71 cases. J Bone Joint Surg. 1995;77(6):847–52.Google Scholar
  24. 24.
    Baxter NN, Habermann EB, Tepper JE, Durham SB, Virnig BA. Risk of pelvic fractures in older women following pelvic irradiation. JAMA. 2005;294(20):2587–93.PubMedPubMedCentralGoogle Scholar
  25. 25.
    Reimer NB, Nystrom LM, Dean CW. Miscellaneous pelvic effects: pelvic/sacral insufficiency fractures. In: Radiation therapy for pelvic malignancy and its consequences. New York: Springer; 2015. p. 167–80.Google Scholar
  26. 26.
    Paice JA. Chronic treatment-related pain in cancer survivors. Pain. 2011;152(3):S84–9.PubMedGoogle Scholar
  27. 27.
    Delanian S, Lefaix JL. The radiation-induced fibroatrophic process: therapeutic perspective via the antioxidant pathway. Radiother Oncol. 2004;73(2):119–31.PubMedGoogle Scholar
  28. 28.
    Martin M, Lefaix JL, Delanian S. TGF-β1 and radiation fibrosis: a master switch and a specific therapeutic target? Int J Radiat Oncol Biol Phys. 2000 May 1;47(2):277–90.Google Scholar
  29. 29.
    Parsons JT, Bova FJ, Fitzgerald CR, Mendenhall WM, Million RR. Radiation optic neuropathy after megavoltage external-beam irradiation: analysis of time-dose factors. Int J Radiat Oncol Biol Phys. 1994;30(4):755–63.PubMedGoogle Scholar
  30. 30.
    Stoll BA, Andrews JT. Radiation-induced peripheral neuropathy. Br Med J. 1966;1(5491):834.PubMedPubMedCentralGoogle Scholar
  31. 31.
    Maier JG, Perry RH, Saylor W, Sulak MH. Radiation myelitis of the dorsolumbar spinal cord. Radiology. 1969;93(1):153–60.PubMedGoogle Scholar
  32. 32.
    Johansson S, Svensson H, Denekamp J. Dose response and latency for radiation-induced fibrosis, edema, and neuropathy in breast cancer patients. Int J Radiat Oncol Biol Phys. 2002;52(5):1207–19.PubMedGoogle Scholar
  33. 33.
    Thomas JE, Cascino TL, Earle JD. Differential diagnosis between radiation and tumor plexopathy of the pelvis. Neurology. 1985;35(1):1.PubMedGoogle Scholar
  34. 34.
    Delanian S, Pradat PF. Posteriori conformal radiotherapy using three-dimensional dosimetric reconstitution in a survivor of adult-onset Hodgkin’s disease for definitive diagnosis of lower motor neuron disease. J Clin Oncol. 2010;28(30):e599–601.PubMedGoogle Scholar
  35. 35.
    Ashenhurst EM, Quartey GR, Starreveld A. Lumbo-sacral radiculopathy induced by radiation. Can J Neurol Sci. 1977;4(04):259–63.PubMedGoogle Scholar
  36. 36.
    Powell S, Cooke J, Parsons C. Radiation-induced brachial plexus injury: follow-up of two different fractionation schedules. Radiother Oncol. 1990;18(3):213–20.PubMedGoogle Scholar
  37. 37.
    Rawlings G, Arriagada R, Fontaine F, Bouhnik H, Mouriesse H, Sarrazin D. Radiation-induced brachial plexopathy. Bull Cancer. 1983;70(2):77–83.PubMedGoogle Scholar
  38. 38.
    Kori SH, Foley KM, Posner JB. Brachial plexus lesions in patients with cancer= 100 cases. Neurology. 1981;31(1):45.PubMedGoogle Scholar
  39. 39.
    Bajrovic A, Rades D, Fehlauer F, Tribius S, Hoeller U, Rudat V, Jung H, Alberti W. Is there a life-long risk of brachial plexopathy after radiotherapy of supraclavicular lymph nodes in breast cancer patients? Radiother Oncol. 2004;71(3):297–301.PubMedGoogle Scholar
  40. 40.
    Kori SH. Diagnosis and management of brachial plexus lesions in cancer patients. Oncology (Williston Park, NY). 1995 Aug;9(8):756–760.Google Scholar
  41. 41.
    Delanian S, Lefaix JL, Pradat PF. Radiation-induced neuropathy in cancer survivors. Radiother Oncol. 2012;105(3):273–82.PubMedPubMedCentralGoogle Scholar
  42. 42.
    Killer HE, Hess K. Natural history of radiation-induced brachial plexopathy compared with surgically treated patients. J Neurol. 1990;237(4):247–50.PubMedGoogle Scholar
  43. 43.
    Roth G, Magistris MR, Le Fort D, Desjacques P. Post-radiation brachial plexopathy. Persistent conduction block. Myokymic discharges and cramps. Rev Neurol. 1987;144(3):173–80.Google Scholar
  44. 44.
    Pradat PF, Delanian S. Late radiation injury to peripheral nerves. Handb Clin Neurol. 2012;115:743–58.Google Scholar
  45. 45.
    Merrell RT. Radiation-induced lumbosacral plexopathy. In: Radiation therapy for pelvic malignancy and its consequences. New York: Springer; 2015. p. 181–7.Google Scholar
  46. 46.
    Feistner H, Weissenborn K, Münte TF, Heinze HJ, Malin JP. Post-irradiation lesions of the caudal roots. Acta Neurol Scand. 1989;80(4):277–81.PubMedGoogle Scholar
  47. 47.
    Danesh-Meyer HV. Radiation-induced optic neuropathy. J Clin Neurosci. 2008;15(2):95–100.PubMedGoogle Scholar
  48. 48.
    Flickinger JC. Cranial nerves. In: Human radiation injury. Philadelphia: Lippincott Williams Wilkins; 2011. p. 210–6.Google Scholar
  49. 49.
    Berger PS, Bataini JP. Radiation-induced cranial nerve palsy. Cancer. 1977;40(1):152–5.PubMedGoogle Scholar
  50. 50.
    Wong CS, Fehlings MG, Sahgal A. Pathobiology of radiation myelopathy and strategies to mitigate injury. Spinal Cord. 2015;53(8):574–80.PubMedGoogle Scholar
  51. 51.
    Schultheiss TE. The radiation dose–response of the human spinal cord. Int J Radiat Oncol Biol Phys. 2008;71(5):1455–9.PubMedGoogle Scholar
  52. 52.
    Kirkpatrick JP, van der Kogel AJ, Schultheiss TE. Radiation dose–volume effects in the spinal cord. Int J Radiat Oncol Biol Phys. 2010;76(3):S42–9.PubMedGoogle Scholar
  53. 53.
    Gibbs IC, Patil C, Gerszten PC, Adler JR Jr, Burton SA. Delayed radiation-induced myelopathy after spinal radiosurgery. Neurosurgery. 2009;64(2):A67–72.PubMedGoogle Scholar
  54. 54.
    Wong CS, Van der Kogel AJ. Mechanisms of radiation injury to the central nervous system: implications for neuroprotection. Mol Interv. 2004;4(5):273.PubMedGoogle Scholar
  55. 55.
    New P. Radiation injury to the nervous system. Curr Opin Neurol. 2001;14(6):725–34.PubMedGoogle Scholar
  56. 56.
    Daly ME, Gibbs IC. Spinal radiosurgery: delayed radiation-induced myelopathy. In: Tumors of the central nervous system, vol. 6. Dordrecht: Springer Netherlands; 2012. p. 135–40.Google Scholar
  57. 57.
    Okada S, Okeda R. Pathology of radiation myelopathy. Neuropathology. 2001;21(4):247–65.PubMedGoogle Scholar
  58. 58.
    Stephans KL, Djemil T, Tendulkar RD, Robinson CG, Reddy CA, Videtic GM. Prediction of chest wall toxicity from lung stereotactic body radiotherapy (SBRT). Int J Radiat Oncol Biol Phys. 2012;82(2):974–80.PubMedGoogle Scholar
  59. 59.
    Din SU, Williams EL, Jackson A, Rosenzweig KE, Wu AJ, Foster A, Yorke ED, Rimner A. Impact of fractionation and dose in a multivariate model for radiation-induced chest wall pain. Int J Radiat Oncol Biol Phys. 2015;93(2):418–24.PubMedPubMedCentralGoogle Scholar
  60. 60.
    Andolino DL, Forquer JA, Henderson MA, Barriger RB, Shapiro RH, Brabham JG, Johnstone PA, Cardenes HR, Fakiris AJ. Chest wall toxicity after stereotactic body radiotherapy for malignant lesions of the lung and liver. Int J Radiat Oncol Biol Phys. 2011;80(3):692–7.PubMedGoogle Scholar
  61. 61.
    Mutter RW, Liu F, Abreu A, Yorke E, Jackson A, Rosenzweig KE. Dose–volume parameters predict for the development of chest wall pain after stereotactic body radiation for lung cancer. Int J Radiat Oncol Biol Phys. 2012;82(5):1783–90.PubMedGoogle Scholar
  62. 62.
    Creach KM, El Naqa I, Bradley JD, Olsen JR, Parikh PJ, Drzymala RE, Bloch C, Robinson CG. Dosimetric predictors of chest wall pain after lung stereotactic body radiotherapy. Radiother Oncol. 2012;104(1):23–7.PubMedGoogle Scholar
  63. 63.
    Welsh J, Thomas J, Shah D, Allen PK, Wei X, Mitchell K, Gao S, Balter P, Komaki R, Chang JY. Obesity increases the risk of chest wall pain from thoracic stereotactic body radiation therapy. Int J Radiat Oncol Biol Phys. 2011;81(1):91–6.PubMedGoogle Scholar
  64. 64.
    Dunlap NE, Cai J, Biedermann GB, Yang W, Benedict SH, Sheng K, Schefter TE, Kavanagh BD, Larner JM. Chest wall volume receiving> 30 Gy predicts risk of severe pain and/or rib fracture after lung stereotactic body radiotherapy. Int J Radiat Oncol Biol Phys. 2010;76(3):796–801.PubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.New York Presbyterian-Weill Cornell Medicine, Department of AnesthesiologyNew YorkUSA
  2. 2.Memorial Sloan Kettering Cancer Center, Department of Anesthesiology and Critical Care MedicineNew YorkUSA
  3. 3.Department of Anesthesiology and Critical CareMemorial Sloan Kettering Cancer CenterNew YorkUSA

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