Pain is a common symptom in patients with cancer that can be associated with varied causes stemming from both the disease and its treatment.1 These can range from local pressure exerted by a tumor to neurological impacts associated with treatments, among other factors.1 Management of pain in patients with cancer can be complicated by the fact that opioids are an effective class of medications for treating cancer-related pain, but they carry the potential for addiction and/or overdose.2 Furthermore, research suggests that pain and its management are phenomena that may be influenced by a person’s genetic makeup.1
For many patients with cancer, especially those with advanced cancer, pain can be difficult to control and often involves a strategy employing nonopioid and opioid analgesics as determined by pain intensity.3 A recent report addressed the use of opioid analgesia for cancer-related pain and highlighted shared guidelines by the National Comprehensive Cancer Network, the American Society for Clinical Oncology, and regulatory agencies in the United States.2 Guidelines by these groups can contribute to strategies for safe and judicious use of opioid and nonopioid analgesic approaches in managing pain associated with cancer and/or its treatment in patients and survivors of cancer.2
Evidence suggests pain related to cancer and/or cancer treatment, as well as responses to analgesic treatment, may involve identifiable genetic components.1,3 The experience of pain has been linked in some cases to single nucleotide polymorphisms (SNPs) that have potential to serve as genetic biomarkers for pain risk.1 Understanding of and further research into genetic polymorphisms associated with cancer-related pain and pain therapy could potentially support a personalized approach to pain management.1,3
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There are many ways that genetic polymorphisms are potentially linked to pain, severity of pain, or sensitivity to preoperative pain in patients with cancer.1 Many genes with identified SNPs are implicated in pain-associated pathways related to inflammation.1 Some examples of these genes include IL-8 and TNF-a.1 The genes COMT and OPRM1 may be linked to preoperative pain sensitivity in processes associated with neurotransmission.1
Several genes with identified SNPs may also be relevant to pain following surgery or treatment with cancer medication.1 Inflammation and neurotransmission are prominent pathways involved in pain following cancer treatment, while other pathways involve drug transport and metabolism or other cellular functions.1 SNPs related to COMT, IL-10, CXCL8, and TNF-a genes can be involved in pain associated with cancer treatment, in addition to several other SNPs that have been identified.1
SNPs have been found to have associations with pain related to cancer treatment through a variety of pathways and circumstances.1 Postsurgical pain may be associated with any of several SNPs in the purinergic P2Y12 receptor (P2RY12) gene.1 Postmastectomy pain of a persistent nature shows a possible connection to SNPs in multiple genes involved with potassium channels.1 Chemotherapy using certain aromatase inhibitors has associations with arthralgia, and this may relate to SNPs in genes from the cytochrome P450 family, in addition to the gene encoding osteoprotegerin.1,4,5 Throat pain in patients treated with radiotherapy for differentiated thyroid cancer has been connected to SNPs in TNF-a, TNF-b, NF-kB, and ATM genes.1,6
This article originally appeared on Oncology Nurse Advisor
