Quinolinic Acid and Chronic Cancer Pain
Main Article Content
Keywords
Chronic cancer pain, Duration of pain, Pain, Pain scale, Quinolinic acid
Abstract
Pain is a complex phenomenon that is influenced by both objective and subjective factors. In patients with cancer undergoing active therapy, the prevalence of chronic pain is estimated to range from 30% to 50%. Given the complex nature of cancer patients' conditions, including impaired physical function, psychological distress, and various other problems, a comprehensive pain assessment is necessary to ensure effective pain management, reduce morbidity, and prevent opioid dependence. Objective measurement of pain is essential to improve the quality of chronic pain services for malignancy, and several biomarkers have been identified as potentially useful tools for measuring chronic pain more objectively. Quinolinic acid is one of these significant biomarkers that have been found to be useful for assessing pain. This study represents the first investigation in Indonesia of the relationship between quinolinic acid and chronic cancer pain. A cross-sectional study was conducted with 85 participants, including 29 male and 56 female patients. The pain scale was measured using the Numerating Rating Scale (NRS) with a range of 0-10, and serum quinolinic acid levels were measured using ELISA. Of the 85 study participants, 29 patients (34.12%) had pelvic organ cancer, 21 patients (24.71%) had head and neck cancer, 12 patients (14.12%) had abdominal organ cancer, 7 patients (8.24%) had breast cancer, 5 patients (5.88%) had pulmonary cancer, 4 patients (4.71%) had skin cancer, and 7 patients (8.24%) had other types of cancer. The study found that the effect of quinolinic acid on the degree of pain was significant (p = 0.024), with a correlation coefficient (r) of 0.244. However, the effect of kynurenic acid on the duration of pain was not significant (p = 0.135). In conclusion, quinolinic acid was found to be correlated with the degree of pain in chronic cancer patients, but it had no correlation with the duration of pain. Further research is needed to explore the potential of quinolinic acid as a biomarker for chronic pain assessment and management in cancer patients.
References
2. Anderson, E. W., Fishbein, J., Hong, J., Roeser, J., Furie, R. A., Aranow, C., Volpe, B. T., Diamond, B., & Mackay, M. (2021). Quinolinic acid, a kynurenine/tryptophan pathway metabolite, associates with impaired cognitive test performance in systemic lupus erythematosus. Lupus Science & Medicine, 8(1), e000559.
3. Athnaiel, O., Ong, C., & Knezevic, N. N. (2022). The Role of Kynurenine and Its Metabolites in Comorbid Chronic Pain and Depression. Metabolites, 12(10), 950.
4. Dahlhamer, J., Lucas, J., Zelaya, C., Nahin, R., Mackey, S., DeBar, L., Kerns, R., Von Korff, M., Porter, L., & Helmick, C. (2018). Prevalence of chronic pain and high-impact chronic pain among adults—United States, 2016. Morbidity and Mortality Weekly Report, 67(36), 1001.
5. Davis, I., & Liu, A. (2015). What is the tryptophan kynurenine pathway and why is it important to neurotherapeutics? Expert Review of Neurotherapeutics, 15(7), 719–721.
6. Gunn, J., Hill, M. M., Cotten, B. M., & Deer, T. R. (2020). An analysis of biomarkers in patients with chronic pain. Pain Physician, 23(1), E41.
7. Haefeli, M., & Elfering, A. (2006). Pain assessment. European Spine Journal, 15, S17–S24.
8. Heron, P., & Daya, S. (2001). 17β-estradiol attenuates quinolinic acid insult in the rat hippocampus. Metabolic Brain Disease, 16, 187–198.
9. Kim, H., Chen, L., Lim, G., Sung, B., Wang, S., McCabe, M. F., Rusanescu, G., Yang, L., Tian, Y., & Mao, J. (2012). Brain indoleamine 2, 3-dioxygenase contributes to the comorbidity of pain and depression. The Journal of Clinical Investigation, 122(8).
10. Lawlor, P. G., Lawlor, N. A., & Reis-Pina, P. (2018). The Edmonton Classification System for Cancer Pain: a tool with potential for an evolving role in cancer pain assessment and management. Expert Review of Quality of Life in Cancer Care, 3(2–3), 47–64.
11. Neufeld, N. J., Elnahal, S. M., & Alvarez, R. H. (2017). Cancer pain: a review of epidemiology, clinical quality and value impact. Future Oncology, 13(9), 833–841.
12. Paul, E. R., Schwieler, L., Erhardt, S., Boda, S., Trepci, A., Kämpe, R., Asratian, A., Holm, L., Yngve, A., & Dantzer, R. (2022). Peripheral and central kynurenine pathway abnormalities in major depression. Brain, Behavior, and Immunity, 101, 136–145.
13. Phillips, C. J. (2009). The cost and burden of chronic pain. Reviews in Pain, 3(1), 2–5.
14. Pope, J. E., Fishman, M. A., Gunn, J. A., Cotten, B. M., Hill, M. M., & Deer, T. R. (2021). Cross-validation of the foundation pain index with PROMIS-29 in chronic pain patients. Journal of Pain Research, 2677–2685.
15. Raja, S. N., Carr, D. B., Cohen, M., Finnerup, N. B., Flor, H., Gibson, S., Keefe, F., Mogil, J. S., Ringkamp, M., & Sluka, K. A. (2020). The revised IASP definition of pain: Concepts, challenges, and compromises. Pain, 161(9), 1976.
16. Rodriguez, C., Ji, M., Wang, H.-L., Padhya, T., & McMillan, S. C. (2019). Cancer pain and quality of life. Journal of Hospice & Palliative Nursing, 21(2), 116–123.
17. Russo, M. M., & Sundaramurthi, T. (2019). An overview of cancer pain: epidemiology and pathophysiology. Seminars in Oncology Nursing, 35(3), 223–228.
18. Sá, K. N., Moreira, L., Baptista, A. F., Yeng, L. T., Teixeira, M. J., Galhardoni, R., & de Andrade, D. C. (2019). Prevalence of chronic pain in developing countries: systematic review and meta-analysis. Pain Reports, 4(6), e779.
19. Steiner, J., Walter, M., Gos, T., Guillemin, G. J., Bernstein, H.-G., Sarnyai, Z., Mawrin, C., Brisch, R., Bielau, H., & zu Schwabedissen, L. M. (2011). Severe depression is associated with increased microglial quinolinic acid in subregions of the anterior cingulate gyrus: evidence for an immune-modulated glutamatergic neurotransmission? Journal of Neuroinflammation, 8(1), 1–9.
20. Van den Beuken-van Everdingen, M. H. J., De Rijke, J. M., Kessels, A. G., Schouten, H. C., Van Kleef, M., & Patijn, J. (2007). Prevalence of pain in patients with cancer: a systematic review of the past 40 years. Annals of Oncology, 18(9), 1437–1449.
21. Verma, K., Chandra, M., Prasad, D. N., Debnath, C., Mohanty, H., Kohli, E., & Reddy, M. P. K. (2022). Alteration in cerebral blood flow, kynurenines with respect to mood profile in freshly recruited armed forces personnel. Journal of Psychiatric Research, 149, 155–161.
22. Walczak, K., Wnorowski, A., Turski, W. A., & Plech, T. (2020). Kynurenic acid and cancer: facts and controversies. Cellular and Molecular Life Sciences, 77(8), 1531–1550.
23. Waloejo, C. S., Rehatta, N. M., Andriyanto, L., Sulistiawan, S. S., Pudjirahardjo, W. J., Farhan, A. B., & Kurniasari, H. (2022). Kynurenic acid as chronic pain biomarker for future cancer pain management. Int J Health Sci, 6(S5), 6020–6032.