• Hadas Nahman-Averbuch, David Yarnitsky, Yelena Granovsky, Elliot Sprecher, Mariana Steiner, Tzahala Tzuk-Shina, and Dorit Pud.
• The Laboratory of Clinical Neurophysiology, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. hadas6@gmail.com
• J Pain Symptom Manage. 2011 Aug 1;42(2):229-38.

ContextSeveral chemotherapy agents induce polyneuropathy that is painful for some patients, but not for others. We assumed that these differences might be attributable to varying patterns of pain modulation.ObjectivesThe aim of the present study was to evaluate pain modulation in such patients.MethodsTwenty-seven patients with chemotherapy-induced polyneuropathy were tested for detection thresholds (cold, warm, and mechanical) in both the forearm and foot, as well as for heat pain threshold, mechanical temporal summation (TS), and conditioned pain modulation (CPM; also known as the diffuse noxious inhibitory control-like effect), which were tested in the upper limbs.ResultsPositive correlations were found between clinical pain levels and both TS (r=0.52, P=0.005) and CPM (r=0.40, P=0.050) for all patients. In addition, higher TS was associated with less efficient CPM (r=0.56, P=0.004). The group of patients with painful polyneuropathy (n=12) showed a significantly higher warm detection threshold in the foot (P=0.03), higher TS (P<0.01), and less efficient CPM (P=0.03) in comparison to the group with nonpainful polyneuropathy.ConclusionThe painfulness of polyneuropathy is associated with a "pronociceptive" modulation pattern, which may be primary to the development of pain. The higher warm sensory thresholds in the painful polyneuropathy group suggest that the severity of polyneuropathy may be another factor in determining its painfulness.Copyright © 2011 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

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