Chemotherapeutic induced neuropathic pain. A review from the literature focusing on its treatments

Abstract

Chemotherapy-induced peripheral neuropathy (CIPN) is a common and debilitating adverse effect of many anticancer agents, presenting with sensory symptoms such as spontaneous pain and mechanical or cold allodynia in a characteristic "stocking and glove" distribution. This neuropathic pain can severely limit the dosage and duration of life-saving chemotherapy, often necessitating treatment modification or cessation, and may persist long after therapy, impairing survivors’ quality of life. Standard pharmacological treatments offer limited efficacy, highlighting the need for alternative therapies. This review summarizes current literature on emerging treatments for CIPN, with a focus on three agents: nabiximols, gabapentin, and phenyl N-tert-butylnitrone (PBN). Nabiximols, a cannabinoid-based oral spray, demonstrated modest efficacy and a favorable safety profile in a small pilot study, suggesting the need for larger clinical trials. Gabapentin, an anticonvulsant, showed potential as an early intervention in patients with mild symptoms, with good tolerability and safety. PBN, a potent free radical scavenger, prevented the development of neuropathic pain in preclinical models of paclitaxel-induced neuropathy, offering promising neuroprotective effects. Collectively, these findings underscore the importance of further clinical and translational research to identify and validate effective therapies for managing CIPN.