FIGHTING CHRONIC PAIN: THE ACADEMIC CRUSADE TO CREATE NEW THERAPIES

Dr. Margarita Calvo, director of the Núcleo Milenio MiNuSPain, participated in the first Webinar on «Neuropathic Oncological Pain» organized by the International Committee of Women in Neuromodulation of the Argentine Society of Neuromodulation (SANE)

In the activity, she presented the results of her work on the neuroprotective potential of this well-known antidiabetic drug, which would prevent neuropathic damage caused by oxaliplatin, one of the drugs most used in chemotherapy.

Those who have suffered or those who know closely the experience of a person who has faced some type of cancer, will understand that the fight for survival is seen, many times, even more uphill due to the penetrating pains that accompany both the disease itself, such as adverse effects of treatment.

This is precisely one of the consequences of oxaliplatin, one of the drugs most used for chemotherapy due to its effective adjuvant role and as a treatment for metastatic disease. However, this drug induces a disabling form of neuropathy that causes severe pain in patients. The intensity of these effects can completely alter people’s daily lives and even make the continuity of the medical procedure unviable, thereby reducing the chances of survival for patients.

This neuropathy occurs because chemotherapy induces damage to the terminals of sensory neurons that are located in the epidermis, where the nociceptors or receptors responsible for sending pain signals to the central nervous system are found. This causes an overreaction of sensory neurons, causing sensory symptoms such as dysesthesia, paresthesia, and cold and mechanical allodynia.

This was part of the presentation that Dr. Margarita Calvo, director of the Millennium Nucleus for the Study of Pain, MiNuSPain; who was invited by the International Committee of Women in Neuromodulation of the Argentine Society of Neuromodulation (SANE), to participate in the first Webinar on “Neuropathic Oncological Pain”. The instance had the participation of about 250 professionals from the scientific and clinical world belonging to 14 Latin American countries, including Argentina, Bolivia, Colombia, Brazil and Chile. 

Regarding her work, Dr. Calvo explained that “Dr. Bruno Nervi, an oncologist, came to our Neuropathic Pain Laboratory to ask us about this problem. He told us that he often had to reduce or stop oxaliplatin treatment, because patients develop peripheral neuropathy that causes neuropathic pain and that, generally, it can be persistent even after chemotherapy has been stopped».The researcher explained that, according to international cohorts, «the incidence of this neuropathy ranges from 60 to 90%, but at least 12% of these patients have a severe neuropathy that limits their daily life,» said the also academic from the Pontificia Universidad Católica de Chile, Dr. Margarita Calvo.

Given the need to maintain oxaliplatin treatment to continue the fight against cancer, the alternative that this team of scientists chose was to look for a drug that could prevent this neuropathy. 

“In the treatment of neuropathic pain, most of the time we are faced with a patient who already has this condition due to various causes, such as diabetes or herpes, without the possibility of preventing that pain. But in the case of cancer pain due to chemotherapy, almost like in any other type of neuropathic pain, we have the possibility of preventing pain because we already know that 60% of the patients who use this therapy will develop it ”, explained the scientist .The study 

With this background, the team of scientists began to establish a pharmacological strategy to prevent or treat oxaliplatin-induced neuropathies. It was then that they arrived at the well-known drug “Metformin”, widely used for the treatment of type 2 diabetes mellitus and which, according to the pre-clinical results of their research, would prevent the development of oxaliplatin-induced neuropathy. 

The results in in-vivo models, published in the journal Neurobiology of Pain, determined that the concomitant use of metformin managed to avoid the degeneration of intraepidermal fibers, gliosis and the alteration of sensitivity. 

The work, entitled “Metformin protects from oxaliplatin induced peripheral neuropaty in rats”, was the result of a joint effort led by Dr. Margarita Calvo and Dr. Bruno Nervi, both from the Pontificia Universidad Católica de Chile, together with Dr. Felipe Court of the Universidad Mayor (Chile) and constitutes a possible new high-impact clinical approach for the use of this drug in cancer patients.

International Meeting

The presentation of this research was carried out within the framework of the 1st Webinar of the International Committee of Women in Neuromodulation, called “Neuropathic Oncological Pain”, an activity organized by the Argentine Society of Neuromodulation (SANE),

One of the organizers of the event, the specialist in Chronic Pain, Dr. Wendy Rojas from Bolivia, indicated that “having been able to learn about the research work in oncological neuropathic pain that is carried out in institutions such as MiNuSPain in Chile or the work that is carried out in the CONICET Laboratory of the Universidad Austral de Argentina or in Pain Units in Spain and that, who carry out these investigations, can exchange about this common concern that they have, is a very important contribution to the knowledge of pain ”. 

The expert added that the contribution of this type of initiative lies in the fact that «this allows us to know what lines of research are being developed in order to overcome problems that we have today in our medical practice in pain medicine».

The presentation of Dr. Margarita Calvo was also joined by the presentation of the head of the Pain Unit of the Hospital Universitario de la Princesa de Madrid (Spain), Dr. Concepción Pérez Hernández, who addressed the “State of the Art in the Treatment of Neuropathic Oncological Pain (Post-chemotherapy, Post-surgical and Post-surgical) ”. On the occasion, the Hispanic researcher provided an update on this matter, showing the prevalence of this type of pain, the available evidence on drugs for the management of the disease and the latest treatment guidelines.

Along with them, the director of the Cancer Pain Laboratory at the Translational Medicine Research Institute, CONICET-Austral in Buenos Aires (Argentina), Dr. María Florencia Coronel, also presented part of her work. The academic specifically addressed the pathophysiological mechanisms that cause post-chemotherapy neuropathic pain, as well as the laboratory results on the use of resveratrol for the prevention and treatment of chemotherapy-induced neuropathies.