Causes of pain include:
- Pain caused by cancer(compression or infiltration of pain sensitive structures) .
- Pain caused by treatment (consequence of radiotherapy, surgery or chemotherapy).
- Pain associated with debilitating disease (postherpetic neuralgia or bedsores).
- Pain unrelated to cancer or treatment (arthritis ,migraine or neuropathy).
The majority of pain is caused by cancer (83%) and /or secondary effects of oncological therapy (28%).
The assessment of the type and the cause of pain is important because the first indicates the appropriate symptomatic therapy and the latter the appropriate treatment of the underlying disease.
Nociceptive pain is caused by stimulation of the free nerve endings (peripheral nociceptors belonging to A-delta and C-fibers).As a result of this stimulation action potentials are transmitted to the central nervous system and perceived as pain.
Nociceptive pain is subdivided into actual nociceptive pain,nociceptive nerve pain or referred pain.Nociceptive pain is diagnosed as pain of new onset and is linked to active tissue damage by tumor occurrence, tumor associated inflammation ,ischemia,trauma (not necessarily cancer related) or subclinical or neural infection.
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Nociceptive nerve pain is diagnosed as pain of slow onset that was localized in the sensory distribution of one of the cranial nerves,peripheral nerves or nerve roots innervating the skull ,face or shoulder and has an established cause of active tissue damage such as tumor recurrence or benign inflammation.
Referred pain is diagnosed as pain of new onset without local cause at the site of pain.Active tissue damage is present in pharynx, hypopharynx,esophagus, trachea or mediastinum supposedly stimulating sympathetic nerve endings and leading to pain in the corresponding region of the face of the skull.
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