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Peripheral Neuropathies
Peripheral nerves can be compressed or infiltrated by tumor or constricted by fibrosis, which in rare instances is a complication of radiation treatment. They may also be damaged by neurotoxic chemotherapy or by cutaneous incisions and the retraction of tissues during surgery (Table 5).
Myeloma may cause a progressive painful neuropathy in about 15 percent of patients. In these patients, neuropathy precedes the onset of other symptoms in as many as 8 of 10.112 This sensorimotor neuropathy is characterized by distal paraesthesia, sensory loss, weakness, and muscle wasting, and it may occasionally ascend in distribution in a manner similar to Guillain-Barre syndrome.
Vincristine, cisplatin, and taxol produce dose-related peripheral neuropathies, usually manifested as dysesthesia in the distal feet and later (as the neuropathy progresses) in the hands; rarely, continuous burning pain is a clinical problem. Vincristine neuropathy may also give rise to cranial neuralgias, including jaw claudication. The treatment of chemotherapy-related neuropathy involves decreasing or stopping the offending agent (when possible) and the use of analgesics.
In the absence of recurrent tumor, persistent pain following surgery may result from intraoperative injury to cutaneous or deeper nerves. Postsurgical pain syndromes are characterized by either persistent pain after the surgical procedure or recurrent pain after the initial surgical pain has resolved. The clinical characteristics relate to the location and extent of nerve injury.254 Treatment of these syndromes involves the use of analgesics and, occasionally, regional nerve blocks.
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