Quantitative sensory findings in patients with bortezomib-induced pain

Bortezomib (PS-341) is a newly developed proteosome inhibitor that shows extremely promising antineoplastic effects against a variety of neoplasias. Neuropathic pain is emerging as a major complication of bortezomib. Although clinical reports have appeared in the literature describing the general symptoms of bortezomib chemoneuropathy, specific quantitative sensory data that detail the sensory deficits that might yield insight to the primary afferent dysfunction contributing to this pain is lacking. In this report, it is shown that patients with bortezomib-induced neuropathic pain have significantly elevated touch detection threshold and slotted peg board time, impaired sharpness detection, and elevated thresholds for the detection of skin warming and heat pain. Patients also had increased reports of cold pain. These data indicate that bortezomib-induced neuropathy is associated with deficits in A beta, A delta, and C caliber primary afferent fibers. Perspective: This work demonstrates that pain induced by the chemotherapy drug bortezomib is accompanied by dysfunction in all fiber types in sensory nerves. Impaired A beta and C sensory function also extends into areas of skin that are not perceived as affected by pain. (C) 2007 by the American Pain Society.