Nerve Decompression for Chemotherapy-Induced Neuropathic Pain

Despite the limited efficacy of current medical treatments, and the fact that they only treat the pain component of chemotherapy-induced peripheral neuropathy (CIPN), until recently there has been little interest in exploring surgical therapies for this condition. This is not at all surprising, because at first blush, it would seem that there is no rationale for a surgical approach to a systemic side effect of a medication ( neurotoxicity). Similar reasoning had previously been applied to other forms of systemic-disease-induced neuropathy, such as diabetic neuropathy. This resulted in a long lag between the recognition of the cause of diabetic neuropathy and the application of a successful surgical treatment to alleviate its effects on the extremities. The lessons learned from the success in the treatment of diabetic neuropathy allowed for investigations into the feasibility of transferring similar techniques into the realm of chemotherapy-induced neuropathy. These surgical techniques have proven to be valuable adjuncts to available medical therapies for this disabling and painful condition. Chemotherapy-induced neuropathy affects a large percentage of patients who receive chemotherapeutic agents. Not all chemotherapy agents cause neuropathy, but platin-based compounds, taxanes, and vinca alkaloids are the most common offenders, among many (Quastohoff et al., 2002). Even the more rarely used thalidomide, and several other atypical chemotherapeutic agents, have a strong correlation with the development of painful neuropathy. For all of these agents, the affect appears CONTENTS