Mechanism-based management of taxane-induced neuropathic pain in breast cancer survivors: a critical review

Taxane-induced neuropathic pain (TINP) is a debilitating condition and represents a significant therapeutic challenge in the treatment of breast cancer. The objective of this critical review is to initially explore the molecular and cellular mechanisms in the peripheral and central nervous systems associated with TINP, including mitochondrial dysfunction, oxidative stress, axonal degeneration, maladaptive neuroplasticity, and neuroimmune activation. The review then proposes to present clinical and experimental interventions that target these peripheral and central pathways, such as pharmacological treatments, invasive and non-invasive neuromodulation techniques, physical activity, manual therapies (including acupuncture and massage), and cryotherapy. Although clinical trials investigating these strategies have shown promising results, several methodological limitations must be considered, such as small sample sizes, heterogeneity in study designs, and the frequent classification of taxane-induced neuropathic pain as a secondary outcome. Therefore, it is concluded that there is a clear need for more methodologically rigorous studies, particularly those involving mechanism-oriented interventions, in the context of TINP rehabilitation in breast cancer.