The Problem of Deafferentation Pain in the Management of the Patient with Cancer

Abstract

The concept of deafferentation and central pain has been slow to penetrate thinking about the management of chronic pain. Treatment strategies for pain caused, not by continual stimulation of nociceptors and continual traffic in nociceptive pathways, but by central neuronal functional abnormalities produced by deafferentation, obviously must differ from the conventional opiate therapy and denervating surgery used in nociceptive pain. It is even less well recognized that cancer commonly causes pain, first, of a nociceptive type by, usually, plexus compression, but later of a deafferentation type resulting from nervous destruction. Cancerous deafferentation pain shares all the characteristics of deafferentation pain caused by non-malignant disease, including resistance to opiates and persistence despite surgical denervation of the painful area. Hence pain in cancer must be carefully scrutinized and attention given to providing appropriate treatment for not only the nociceptive but also the commonly associated deafferentation element.