Neuropathic pain in cancer and AIDS

Neuropathic pain is highly prevalent in patients with cancer and patients w ith AIDS, has profound effects on ability to function and quality of life, and is undertreated. Multiple obstacles to the adequate treatment of pain i n patients with cancer and AIDS have been identified. Specific factors rele vant to neuropathic pain, as well as the prevalence of substance abuse diso rders in the AIDS population, contribute heavily to the undertreatment of p ain in these patients. The differential diagnosis of neuropathic pain in th ese settings is broad, and a methodical diagnostic approach is required to achieve the primary objective of effective primary therapy. The parallel ob jective of providing optimal analgesic treatment also requires an aggressiv e and systematic approach. The presence of comorbid substance abuse issues requires special considerations that ordinarily do not compromise analgesic approaches. This review summarized the neuropathic pain syndromes seen in cancer and in AIDS, presents principles of pain assessment, highlights trea tment options, and addresses the issue of pain and chemical dependency.