Original article
Neuropathic pain in cancer patients treated with bortezomib
Dolor neuropático en pacientes oncológicos en tratamiento con bortezomib
S. Expósito Vizcaínoa,c,d,f,
, J. Casanova-Mollàb,f, L. Escodaa,f, S. Galánc,d,e,f, J. Miróc,d,e,f
Corresponding author
a Servicio de Hematología, Hospital Universitario Joan XXIII de Tarragona, Tarragona, Spain
b Servicio de Neurología, Hospital Universitario Joan XXIII de Tarragona, Tarragona, Spain
c Cátedra de Dolor Infantil URV-Fundación Grünenthal, Unidad para el Estudio y Tratamiento del Dolor-ALGOS, Tarragona, Spain
d Centre de Recerca en Avaluació i Mesura del Comportament (CRAMC), Tarragona, Spain
e Departamento de Psicología, Universitat Rovira i Virgili, Tarragona, Spain
f Institut d’Investigació Sanitària Pere Virgili, Tarragona, Spain
Read
3718
Timeswas read the article
810
Total PDF
2908
Total HTML
Share statistics
array:25 [ "pii" => "S2173580817301578" "issn" => "21735808" "doi" => "10.1016/j.nrleng.2016.05.005" "estado" => "S300" "fechaPublicacion" => "2018-01-01" "aid" => "929" "copyright" => "Sociedad Española de Neurología" "copyrightAnyo" => "2016" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Neurologia. 2018;33:28-34" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1078 "formatos" => array:3 [ "EPUB" => 54 "HTML" => 754 "PDF" => 270 ] ] "Traduccion" => array:1 [ "es" => array:20 [ "pii" => "S0213485316300846" "issn" => "02134853" "doi" => "10.1016/j.nrl.2016.05.008" "estado" => "S300" "fechaPublicacion" => "2018-01-01" "aid" => "929" "copyright" => "Sociedad Española de Neurología" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Neurologia. 2018;33:28-34" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2212 "formatos" => array:3 [ "EPUB" => 68 "HTML" => 1336 "PDF" => 808 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">ORIGINAL</span>" "titulo" => "Dolor neuropático en pacientes oncológicos en tratamiento con bortezomib" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "28" "paginaFinal" => "34" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Neuropathic pain in cancer patients treated with bortezomib" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1043 "Ancho" => 1610 "Tamanyo" => 57955 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Distribución de los grados de neuropatía asociada a bortezomib.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "S. Expósito Vizcaíno, J. Casanova-Mollà, L. Escoda, S. Galán, J. Miró" "autores" => array:5 [ 0 => array:2 [ "nombre" => "S." "apellidos" => "Expósito Vizcaíno" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Casanova-Mollà" ] 2 => array:2 [ "nombre" => "L." "apellidos" => "Escoda" ] 3 => array:2 [ "nombre" => "S." "apellidos" => "Galán" ] 4 => array:2 [ "nombre" => "J." "apellidos" => "Miró" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173580817301578" "doi" => "10.1016/j.nrleng.2016.05.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173580817301578?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213485316300846?idApp=UINPBA00004N" "url" => "/02134853/0000003300000001/v1_201801160512/S0213485316300846/v1_201801160512/es/main.assets" ] ] "itemSiguiente" => array:20 [ "pii" => "S2173580817301499" "issn" => "21735808" "doi" => "10.1016/j.nrleng.2015.02.006" "estado" => "S300" "fechaPublicacion" => "2018-01-01" "aid" => "731" "copyright" => "Sociedad Española de Neurología" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "ssu" "cita" => "Neurologia. 2018;33:35-46" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 957 "formatos" => array:3 [ "EPUB" => 72 "HTML" => 689 "PDF" => 196 ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review article</span>" "titulo" => "Report by the Spanish Foundation for the Brain on the social impact of amyotrophic lateral sclerosis and other neuromuscular disorders" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "35" "paginaFinal" => "46" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Informe de la Fundación Del Cerebro sobre el impacto social de la esclerosis lateral amiotrófica y las enfermedades neuromusculares" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Camacho, J. Esteban, C. Paradas" "autores" => array:3 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Camacho" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Esteban" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Paradas" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0213485315000341" "doi" => "10.1016/j.nrl.2015.02.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213485315000341?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173580817301499?idApp=UINPBA00004N" "url" => "/21735808/0000003300000001/v1_201803061529/S2173580817301499/v1_201803061529/en/main.assets" ] "itemAnterior" => array:20 [ "pii" => "S2173580817300688" "issn" => "21735808" "doi" => "10.1016/j.nrleng.2016.05.004" "estado" => "S300" "fechaPublicacion" => "2018-01-01" "aid" => "931" "copyright" => "Sociedad Española de Neurología" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Neurologia. 2018;33:18-27" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2907 "formatos" => array:3 [ "EPUB" => 70 "HTML" => 2100 "PDF" => 737 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Anti-Ma and anti-Ma2-associated paraneoplastic neurological syndromes" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "18" "paginaFinal" => "27" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Síndromes neurológicos paraneoplásicos asociados a anticuerpos anti-Ma y anti-Ma2" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 817 "Ancho" => 975 "Tamanyo" => 92430 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Immunohistochemical study of rat cerebellum incubated with serum from a patient with anti-Ma2 antibodies using the immunoperoxidase technique with avidin-biotin-peroxidase complex. We observed reactivity in the shape of large intracytoplasmic dots in neurons of the dentate nucleus.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "G. Ortega Suero, N. Sola-Valls, D. Escudero, A. Saiz, F. Graus" "autores" => array:5 [ 0 => array:2 [ "nombre" => "G." "apellidos" => "Ortega Suero" ] 1 => array:2 [ "nombre" => "N." "apellidos" => "Sola-Valls" ] 2 => array:2 [ "nombre" => "D." "apellidos" => "Escudero" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Saiz" ] 4 => array:2 [ "nombre" => "F." "apellidos" => "Graus" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S021348531630086X" "doi" => "10.1016/j.nrl.2016.05.010" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S021348531630086X?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173580817300688?idApp=UINPBA00004N" "url" => "/21735808/0000003300000001/v1_201803061529/S2173580817300688/v1_201803061529/en/main.assets" ] "en" => array:21 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Neuropathic pain in cancer patients treated with bortezomib" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "28" "paginaFinal" => "34" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "S. Expósito Vizcaíno, J. Casanova-Mollà, L. Escoda, S. Galán, J. Miró" "autores" => array:5 [ 0 => array:4 [ "nombre" => "S." "apellidos" => "Expósito Vizcaíno" "email" => array:1 [ 0 => "soniaexposito@hotmail.es" ] "referencia" => array:5 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] 3 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">f</span>" "identificador" => "aff0030" ] 4 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "J." "apellidos" => "Casanova-Mollà" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">f</span>" "identificador" => "aff0030" ] ] ] 2 => array:3 [ "nombre" => "L." "apellidos" => "Escoda" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">f</span>" "identificador" => "aff0030" ] ] ] 3 => array:3 [ "nombre" => "S." "apellidos" => "Galán" "referencia" => array:4 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] 3 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">f</span>" "identificador" => "aff0030" ] ] ] 4 => array:3 [ "nombre" => "J." "apellidos" => "Miró" "referencia" => array:4 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] 3 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">f</span>" "identificador" => "aff0030" ] ] ] ] "afiliaciones" => array:6 [ 0 => array:3 [ "entidad" => "Servicio de Hematología, Hospital Universitario Joan XXIII de Tarragona, Tarragona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Neurología, Hospital Universitario Joan XXIII de Tarragona, Tarragona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Cátedra de Dolor Infantil URV-Fundación Grünenthal, Unidad para el Estudio y Tratamiento del Dolor-ALGOS, Tarragona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Centre de Recerca en Avaluació i Mesura del Comportament (CRAMC), Tarragona, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Departamento de Psicología, Universitat Rovira i Virgili, Tarragona, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Institut d’Investigació Sanitària Pere Virgili, Tarragona, Spain" "etiqueta" => "f" "identificador" => "aff0030" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Dolor neuropático en pacientes oncológicos en tratamiento con bortezomib" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1047 "Ancho" => 1610 "Tamanyo" => 56790 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Distribution of degrees of bortezomib-induced neuropathy in our sample.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Multiple myeloma (MM) is the second most frequent haematologic neoplasia, after lymphoma, accounting for approximately 1% of all cases of cancer in Spain<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">1</span></a> and the rest of Western Europe.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">2</span></a> It is estimated that 10% to 13% of all patients with haematologic neoplasia have MM, with an incidence of 3 to 5 cases per 100<span class="elsevierStyleHsp" style=""></span>000 person-years in Spain,<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">1</span></a> a rate somewhat lower than that reported for Europe (4-6 cases per 100<span class="elsevierStyleHsp" style=""></span>000 person-years).</p><p id="par0010" class="elsevierStylePara elsevierViewall">The introduction of bortezomib as a treatment for MM has significantly improved the life expectancy of these patients. However, this drug is associated with a significant risk of peripheral neuropathy.<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">3-5</span></a> The neurotoxic effect of this drug is caused by a number of mechanisms that affect axonal transport and cause inflammatory damage to sensory neurons.<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">6</span></a> In addition to other pathophysiological mechanisms, such as increased expression of inflammatory mediators, primarily cytokines<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">7</span></a> (tumour necrosis factor<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">8</span></a> or interleukin-1<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">8,9</span></a>), we should also mention such other mechanisms as genetic predisposition to the disease and changes in ion channels and intracellular signalling.<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">7</span></a> As a result, neuropathic pain is the main clinical expression of chemotherapy-induced peripheral neuropathy (CIPN) associated with bortezomib.<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">10</span></a> In CIPN, small nerve fibres conveying temperature and pain information (unmyelinated C fibres and thinly myelinated Aδ fibres) undergo early, selective degeneration (small fibre neuropathy [SFN]).<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">5,11</span></a> At more advanced stages, the disease affects the entire peripheral nerve, including thicker myelinated fibres (Aß fibres),<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">11,12</span></a> leading to severe sensory deficits (vibration and tactile hypoaesthesia, mixed fibre neuropathy [MFN]), and can even involve motor fibres, causing impaired mobility.<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">3,12,13</span></a> This pain is sometimes difficult to describe; it is normally intense, stabbing, or burning, and may be accompanied by a tingling sensation or anodynia. This type of pain interferes with sleep and the activities of daily living (ADL) and can be highly incapacitating.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Neuropathic pain is therefore of great importance, both as an early marker of CIPN associated with bortezomib, and because of its great impact on quality of life.<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">14</span></a> It affects multiple functional and emotional aspects of a patient's main daily living areas, decreasing sleep quality<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">15,16</span></a> and negatively affecting mood,<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">17-19</span></a> mobility,<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">3,18,20</span></a> and social interaction.<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">19</span></a> However, neuropathic pain is difficult to characterise, since on occasion it is non-specific or disproportionate to the objective data on the patient's neuropathy. This difficulty is compounded by the fact that neuropathic pain is similar to or adds to other types of pain, such as bone pain due to pathological fractures. Therefore, specialised care and staff training are required. Furthermore, no easy-to-administer scales assessing both neuropathic pain and CIPN are available to date.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The purpose of our study is twofold: to identify and describe neuropathic pain in a group of patients diagnosed with MM and treated with bortezomib, and to evaluate the impact of pain on ADLs. In line with previous studies, we hypothesised that a significant percentage of patients would report neuropathic pain and that this would be associated with the presence of significant limitations in all ADLs.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Participants</span><p id="par0025" class="elsevierStylePara elsevierViewall">All adult patients diagnosed with MM, receiving intravenous bortezomib (Velcade<span class="elsevierStyleSup">®</span>), and treated at Hospital Universitario Joan XXIII, in Tarragona, in 2013, were considered for inclusion in our study. The inclusion and exclusion criteria were as follows:</p><p id="par0030" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Inclusion criteria</span>: being 18 or older, having a diagnosis of MM, and being eligible for treatment with bortezomib.</p><p id="par0035" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Exclusion criteria</span>: presenting cognitive or psychiatric alterations that may interfere with proper comprehension of interview questions, experiencing severe complications of the disease, having been admitted to the intensive care unit, or having a history of polyneuropathy or diabetes mellitus.</p><p id="par0040" class="elsevierStylePara elsevierViewall">All participants were included in the study after undergoing haematological diagnosis in their first treatment visit (at the haematology day centre at Hospital Universitario Joan XXIII), agreeing to participate in the study, and signing informed consent forms. The study was approved by our centre's Ethics Committee.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Variables and measurement instruments</span><p id="par0045" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0050" class="elsevierStylePara elsevierViewall">Descriptive and sociodemographic data: we recorded each patient's age and sex. Medical histories were reviewed to gather data about the type of chemotherapy used for each patient.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0055" class="elsevierStylePara elsevierViewall">Degree of neuropathy: we used the World Health Organization Common Toxicity Criteria for Peripheral Neuropathy, which establishes 5 different grades: grade 0, no symptoms of neuropathy; grade 1, paraesthesia or weakness but no pain or function loss; grade 2, pain affecting function but not interfering with ADLs; grade 3, pain interfering with ADLs; and grade 4, motor impairment and/or disabling pain.<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">21</span></a></p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0060" class="elsevierStylePara elsevierViewall">Presence of neuropathic pain: we used the Spanish-language version of the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) pain scale,<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">22</span></a> which identifies neuropathic pain by assessing symptoms in 6 dimensions. Scores higher than 12 indicate a high likelihood of neuropathic pain.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">-</span><p id="par0065" class="elsevierStylePara elsevierViewall">Symptom characterisation and clinical examination of neuropathic pain: we used the Spanish-language version of the Neuropathic Pain Diagnostic Questionnaire (DN-4),<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">23</span></a> which evaluates symptoms of neuropathic pain and the main signs of sensory neuropathy with 4 items: 1) pain characteristics: 1.1) burning, 1.2) painful cold, 1.3) electric shocks; 2) sensory symptoms: 2.1) tingling, 2.2) pins and needles, 2.3) numbness, 2.4) itching; 3) sensitivity: 3.1) hypoaesthesia to touch, 3.2) hypoaesthesia to prick; and 4) presence of dynamic mechanical allodynia. The neuropathy examination also assessed the presence or absence of Achilles reflexes. Therefore, assessment of the signs and symptoms included in the DN-4, combined with evaluation of presence or absence of Achilles reflexes, was regarded as the modified DN-4. We classified as “positive” symptoms those assessed by items 1.1, 1.2, 3.2, and 4 of the DN-4, which were regarded as the most representative symptoms of SFN. “Negative” symptoms, compatible with mixed or global involvement of sensory nerve fibres (mixed peripheral neuropathy [MPN]), were assessed with items 2.3 and 3.1; an additional point was scored for each absent Achilles reflex (right or left). We thus determined whether patients met at least 3 of the 4 “positive” (SFN) or “negative” (MPN) symptoms. This classification did not include items 1.3, 2.1, 2.2, or 2.4, since these assess non-specific symptoms shared by both clinical entities.</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">-</span><p id="par0070" class="elsevierStylePara elsevierViewall">Impact of pain on ADLs: we administered the Spanish-language version of the Brief Pain Inventory.<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">24</span></a> This questionnaire includes 11 items evaluating the impact of pain on different ADLs on a numeric scale from 0 (no pain/no impact on ADLs) to 10 (worst pain possible/major impact on ADLs). Pain intensity is classified as mild or no pain (0-3), moderate (4-6), or severe (≥7).</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">-</span><p id="par0075" class="elsevierStylePara elsevierViewall">Pain-related disability: the Spanish-language version of the Oswestry Disability Index was used.<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">25</span></a> This index is obtained by dividing the total score of the questionnaire by the number of sections answered and multiplying by 100. Values of 0% to 20% indicate minimal disability, 21% to 40% moderate disability, 41% to 60% severe disability, and 61% to 80% indicates that the patient is unable to work or perform ADLs, and that an intervention may be required. Values over 80% should be interpreted with caution as they may be indicative of symptom exaggeration.<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">26</span></a></p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">-</span><p id="par0080" class="elsevierStylePara elsevierViewall">Symptoms regarded by the patient as adverse effects were recorded at the end of the treatment. Evaluating quality of life based on subjective perceptions is common practice.<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">27,28</span></a> We enquired about the symptoms described in the literature: nausea and/or vomiting, diarrhoea, constipation, fatigue, anorexia, and pain. Furthermore, the last question was open-ended so that patients could report any additional symptoms that were not listed on the scale. Participants were asked to assess the impact of these symptoms on quality of life on a scale from 0 (no impact) to 10 (greatest possible impact).</p></li></ul></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Statistical analysis</span><p id="par0085" class="elsevierStylePara elsevierViewall">We conducted a descriptive analysis of data (mean age<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>SD, age range, sex distribution, and diagnosis). The Kruskal-Wallis test was then used to compare the different groups of neuropathy. The association between disability and the degree of neuropathy was assessed with the Spearman correlation coefficient. Statistical analysis was performed using SPSS, version 15.</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><p id="par0090" class="elsevierStylePara elsevierViewall">A total of 22 adults who had been diagnosed with MM and were undergoing treatment with bortezomib participated in the study. Half of the patients developed a significant degree of neuropathy; 9 of these (41% of the total sample) completed the study and the remaining 2 died before study completion. Four patients were administered thalidomide during the study period. In one of these, Velcade<span class="elsevierStyleSup">®</span> was replaced by thalidomide due to onset of peripheral neuropathy and severe neuropathic pain. In the remaining 3 patients, both drugs were combined from the time chemotherapy was started, although at low doses. All patients with CIPN (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>14) showed a similar MM stage and degree of bone damage (presence or absence of pathological fractures). Eleven of these (79%) had bone pain. Additional patient characteristics are listed in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Neuropathic pain: distribution and characteristics</span><p id="par0095" class="elsevierStylePara elsevierViewall">Eleven participants (50%) met the WHO criteria for peripheral neuropathy; in all of these patients, symptoms appeared after the second cycle of bortezomib. <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> classifies patients by degree of neuropathy. Grade 2 was the most common (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>5; 36%). Pain usually affected the toes and the soles of the feet (100% of the patients reported pain in these locations) and, to a lesser extent, the upper limbs, especially the hands (56%). No significant neuropathy was identified in 3 patients (14%) after treatment was completed (grade 0 of the WHO scale). In the remaining participants (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>8; 36%), neuropathy and/or its association with the drug could not reliably be determined.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">A total of 5 participants (56%) mainly had positive symptoms (modified DN-4 2.2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.97), whereas 2 patients (22%) predominantly had negative symptoms (modified DN-4 1.7<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.66). These results are shown in <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>. Two patients had similar scores for both SFN and MPN items. No statistically significant differences were found between groups for degree of neuropathy or level of disability according to the Oswestry Disability Index (Kruskal-Wallis H [2]<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.17, <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.92 and H [6]<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>3.2, <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.78, respectively).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Neuropathic pain: impact on activities of daily living</span><p id="par0105" class="elsevierStylePara elsevierViewall">Pain had a significant or very significant impact on ADLs. Of all ADLs included in the study, neuropathic pain had the greatest impact on ability to enjoy life and the least pronounced impact on walking ability. Regarding the degree of neuropathy, our results showed a trend towards statistical significance (Spearman rho<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.65, <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.06); the higher the degree of neuropathy, the more severe the disability (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Furthermore, neuropathic pain was observed to have an impact on ADLs even when pain intensity and the degree of neuropathy were low (pain intensity <<span class="elsevierStyleHsp" style=""></span>4, grade 1 of the WHO scale). <a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a> shows the impact of pain on ADLs.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Other adverse effects of bortezomib</span><p id="par0110" class="elsevierStylePara elsevierViewall">Peripheral neuropathy and fatigue were the main adverse effects of bortezomib in our sample (78% and 67%, respectively). Other adverse effects were reported to a lesser extent: constipation (55%), diarrhoea (44%), anorexia (33%), nausea and vomiting (22%), and sweating (11%).</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discussion</span><p id="par0115" class="elsevierStylePara elsevierViewall">This study has evaluated the presence of neuropathic pain, its characteristics, and its impact on ADLs in a sample of adult patients with MM undergoing treatment with bortezomib. Our results show that neuropathic pain is a frequent complication in these patients and has a negative impact on ADLs in patients treated with bortezomib.</p><p id="par0120" class="elsevierStylePara elsevierViewall">The percentage of patients with CIPN associated with bortezomib in our sample (49%) is similar to those reported in the literature (30%-60%).<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">10,29,30</span></a> This type of neuropathy is mainly sensory; neuropathic pain and other “positive” symptoms are the symptoms most frequently detected during examination. Neuropathic pain may therefore be considered an indicator of the toxicity of this drug.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">11</span></a> Various neurophysiological and histological techniques have been developed to precisely determine the onset of axonal damage.<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">31</span></a> However, these techniques can be complex. The use of such clinical scales as those used in this study may therefore be of assistance in this process and provide a valid approach using the descriptors of the DN-4 scale and other factors for evaluating neuropathy, such as Achilles reflexes. Although our results are satisfactory, further studies with larger sample sizes are necessary to confirm their validity and reliability.</p><p id="par0125" class="elsevierStylePara elsevierViewall">According to our study, neuropathic pain has a significant impact on ADLs. In fact, our results confirm a strong association between neuropathic pain and disability, with disability rates of 30% in patients with grade 1 neuropathy and up to 67% in those with grade 3 neuropathy.</p><p id="par0130" class="elsevierStylePara elsevierViewall">The parameter most severely affected by neuropathic pain was ability to enjoy life, although such other areas as functionality, night-time sleep, and mood have also been found to be significantly altered in these patients. However, although these areas may be affected by other disease-related factors, properly evaluating different areas such as sleep, physical activity, or mood may help establish more suitable treatments to minimise the impact on patients’ quality of life. As shown in our study, even low degrees of neuropathy (≤<span class="elsevierStyleHsp" style=""></span>WHO grade 2) may be associated with significant disability.</p><p id="par0135" class="elsevierStylePara elsevierViewall">Among all the reported adverse effects of bortezomib, peripheral neuropathy is the most disabling.<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">32,33</span></a> In fact, in our study this adverse effect was considered the most disabling by the participants themselves. Long-term disability associated with CIPN, including bortezomib-induced disability, has a negative impact on quality of life, which explains the insistence on the development of neuroprotective agents and early diagnosis of neurotoxicity. In line with this idea, for example, physicians may develop an assessment protocol to detect neuropathy at all stages of treatment, follow up neuropathic pain symptoms, and adapt treatment to each patient's needs. Further research should aim to identify other risk factors that have not yet been defined and which may be helpful in designing more personalised treatments. This information may also be useful in designing specific support programmes to improve the quality of life of these patients once treatment is completed.</p><p id="par0140" class="elsevierStylePara elsevierViewall">Our study is not exempt from certain limitations. First, the occurrence of acute complications and even patient drop-outs during the study period due to disease progression or death may prevent us from generalising our results. However, we hypothesise that these factors may have had little to no effect, given that our results are consistent with those reported in the literature. Second, the cross-sectional nature of this study prevents us from determining whether residual neuropathy is permanent or resolves at a later time. Future research should focus on determining the degree of long-term impairment and disability affecting these patients. This information will be helpful for designing treatment plans or guidelines to minimise the impact of neuropathy on patients’ ADLs and quality of life. Lastly, the lack of data from other neurophysiological (nerve conduction studies or thermal threshold testing) or histological studies (study of cutaneous innervation) conducted before or after treatment makes it impossible to determine the precise percentage of asymptomatic patients who developed subclinical peripheral neuropathy.</p><p id="par0145" class="elsevierStylePara elsevierViewall">Despite these limitations, our study further emphasises the importance of assessing neuropathic pain in cancer patients undergoing chemotherapy, especially with bortezomib. We recommend conducting a baseline assessment using easy, quick-to-administer tools for early detection of the initial symptoms of neuropathy. Likewise, analysing ADLs in these patients helps clearly identify the most affected areas with a view towards designing specific preventive treatments or strategies. The limitations perceived by patients themselves with regard to the main adverse effects underscore the need to train patients to identify and report initial symptoms as early as possible. Our results may help the healthcare professionals managing these patients to adapt drug administration protocols to their individual characteristics and their objective and perceived needs.</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Funding</span><p id="par0150" class="elsevierStylePara elsevierViewall">This study has received no funding of any kind.</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflicts of interest</span><p id="par0155" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres995560" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec958921" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres995561" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec958920" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Participants" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Variables and measurement instruments" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Statistical analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0030" "titulo" => "Results" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0035" "titulo" => "Neuropathic pain: distribution and characteristics" ] 1 => array:2 [ "identificador" => "sec0040" "titulo" => "Neuropathic pain: impact on activities of daily living" ] 2 => array:2 [ "identificador" => "sec0045" "titulo" => "Other adverse effects of bortezomib" ] ] ] 7 => array:2 [ "identificador" => "sec0050" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0055" "titulo" => "Funding" ] 9 => array:2 [ "identificador" => "sec0060" "titulo" => "Conflicts of interest" ] 10 => array:2 [ "identificador" => "xack336427" "titulo" => "Acknowledgements" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-01-25" "fechaAceptado" => "2016-05-04" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec958921" "palabras" => array:6 [ 0 => "Pain" 1 => "Peripheral neuropathy" 2 => "Bortezomib" 3 => "Multiple myeloma" 4 => "Early detection" 5 => "Effects on activities of daily living" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec958920" "palabras" => array:6 [ 0 => "Dolor" 1 => "Neuropatía periférica" 2 => "Bortezomib" 3 => "Mieloma múltiple" 4 => "Detección precoz" 5 => "Repercusiones en las Actividades de la vida diaria" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The neuropathic pain is the most habitual problem in the neuropathy induced by chemotherapy (NIQ) and the one that more interferes in the quality of life of the patients. His precocious detection turns out to be fundamental to reduce or to eliminate the problems that from this one stem. The aims of this study were: 1) determine the incident and NIQ's characteristics and neuropathic pain in patients with mieloma multiple (MM) treated with bortezomib, and 2) to evaluate the impact of the neuropathic pain in the activities of the daily life (AVD).</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">All the patients diagnosed of MM candidates for treatment with bortezomib attended in the Hospital Joan XXIII during 2013, took part. The participants were interviewed individually and were reporting on the presence, the characteristics and the impact of the pain, as well as of the adverse effects of the bortezomib.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">There took part 22 persons, of which NIQ presented the half, being the degree 2 the predominant one. The most habitual location of the neuropathic pain was hands and feet; it was appearing in a spontaneous and progressive way deteriorating in rest and during the night, with predominance of positive symptoms. The impact of the pain was reflected in all the AVD. The principal limitation was the disability to enjoy the life. The peripheral neuropathy occupied the first place in order of subjective importance for the patient followed by the fatigue and the constipation.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A proper assessment and early detection of neuropathic pain is critical to minimising its impact on the quality of life of patients.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducción</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El dolor neuropático es el problema más habitual en la neuropatía inducida por quimioterapia (NIQ) y el que más interfiere en la calidad de vida de los pacientes. Su detección precoz resulta fundamental para reducir o eliminar los problemas que de este se derivan. Los objetivos de este estudio eran: <span class="elsevierStyleItalic">1)</span> determinar la incidencia y las características de NIQ y dolor neuropático en pacientes con mieloma múltiple (MM) tratados con bortezomib, y <span class="elsevierStyleItalic">2)</span> evaluar el impacto del dolor neuropático en las actividades de la vida diaria (AVD).</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Método</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Todos los pacientes diagnosticados de MM candidatos a tratamiento con bortezomib atendidos en el Hospital Joan XXIII durante 2013, participaron. Los participantes eran entrevistados individualmente e informaban sobre la presencia, las características y el impacto del dolor, así como de los efectos adversos del bortezomib.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Participaron 22 personas, de las cuales la mitad presentaron NIQ, siendo el grado 2 el predominante. La localización más habitual del dolor neuropático era manos y pies; aparecía de manera espontánea y progresiva empeorando en reposo y durante la noche, con predominio de síntomas positivos. El impacto del dolor se reflejó en todas las AVD. La limitación principal fue la incapacidad para disfrutar de la vida. La neuropatía periférica ocupó el primer lugar en orden de importancia subjetiva para el paciente seguido de la fatiga y el estreñimiento.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Una adecuada evaluación y detección precoz del dolor neuropático es fundamental para minimizar su impacto en la calidad de vida del paciente.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Vizcaíno SE, Casanova-Mollà J, Escoda L, Galán S, Miró J. Dolor neuropático en pacientes oncológicos en tratamiento con bortezomib. Neurología. 2018;33:28–34.</p>" ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1047 "Ancho" => 1610 "Tamanyo" => 56790 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Distribution of degrees of bortezomib-induced neuropathy in our sample.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1120 "Ancho" => 1556 "Tamanyo" => 45793 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Positive (SFN) and negative symptoms (MPN) of bortezomib-induced neuropathy.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1079 "Ancho" => 1454 "Tamanyo" => 49208 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Association between degree of neuropathy and disability.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 813 "Ancho" => 1596 "Tamanyo" => 75568 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Impact of pain on the activities of daily living.</p>" ] ] 4 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">SD: standard deviation; N: number of patients; SFN: small fibre neuropathy; MPN: mixed peripheral neuropathy.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">Participants (N)</span> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">22 \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Mean age, years</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">±</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">SD</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">63.8<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>11.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Sex, n (%)</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Men \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11 (50%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Women \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11 (50%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Neuropathy</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Symptom onset</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">100% (2nd cycle) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Neuropathy grade</span> (<span class="elsevierStyleItalic">0</span>-<span class="elsevierStyleItalic">4</span>)</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 (14%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 (36%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 (29%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Disability</span> (<span class="elsevierStyleItalic">0%</span>-<span class="elsevierStyleItalic">100%</span>)</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Total no. of participants: 9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">50.88<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>25.22 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Grade 1 neuropathy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">30<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>21.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Grade 2 neuropathy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">49<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>18.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Grade 3 neuropathy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">67<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>21.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Grade 4 neuropathy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">DN-4 (nerve fibre involvement)</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>SFN \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 (56%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>MPN \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 (22%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>SFN<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>MPN \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 (22%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Pain intensity</span> (<span class="elsevierStyleItalic">0</span>-<span class="elsevierStyleItalic">10</span>)</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mean maximum pain intensity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7.8<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mean minimum pain intensity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.4<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mean pain intensity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4.5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Location</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Lower limbs (toes and soles) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9 (100%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Upper limbs (hands) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 (56%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">LANSS</span> (<span class="elsevierStyleItalic">0</span>-<span class="elsevierStyleItalic">24</span>)</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Total no. of participants: 9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10.11<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.22 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Grade 1 neuropathy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8.33<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3.51 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Grade 2 neuropathy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">14.5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>6.36 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Grade 3 neuropathy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9.25<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2.98 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Grade 4 neuropathy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1688243.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Participants’ characteristics.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:33 [ 0 => array:3 [ "identificador" => "bib0170" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Asociación Española contra el Cáncer (AECC 2015). Available from: <a id="intr0010" class="elsevierStyleInterRef" href="https://www.aecc.es/SobreElCancer/CancerPorLocalizacion/mielomamultiple/Paginas/incidencia.aspx">https://www.aecc.es/SobreElCancer/CancerPorLocalizacion/mielomamultiple/Paginas/incidencia.aspx</a> [accessed 27.01.13]." ] ] ] 1 => array:3 [ "identificador" => "bib0175" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Libro blanco del mieloma múltiple en España 2004" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A. Alegre" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2005" "editorial" => "Fundación leucemia y linfoma, Novartis Farmacéutica S.A." "editorialLocalizacion" => "Madrid" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0180" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "[review]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chemotherapy-induced peripheral neuropathy: an unresolved issue" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R. Velasco" 1 => "J. Bruna" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Neurology" "fecha" => "2010" "volumen" => "25" "paginaInicial" => "116" "paginaFinal" => "131" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0185" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Höke" 1 => "M. Ray" 2 => "J. Ilar" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rodent models of chemotherapy-induced peripheral neuropathy" "fecha" => "2014" "volumen" => "54" "paginaInicial" => "273" "paginaFinal" => "281" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0190" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. Alé" 1 => "J. Bruna" 2 => "M. Herrando" 3 => "X. Navarro" 4 => "E. Udina" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Toxic effects of bortezomib on primary sensory neurons and Schwann cells of adult mice" "fecha" => "2015" "volumen" => "27" "paginaInicial" => "430" "paginaFinal" => "440" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0195" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chronic pain in the cancer survivor: a new frontier" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A.W. Burton" 1 => "G.J. Fanciullo" 2 => "R.D. Beasley" 3 => "M.J. Fisch" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1526-4637.2006.00220.x" "Revista" => array:6 [ "tituloSerie" => "Pain Med" "fecha" => "2007" "volumen" => "8" "paginaInicial" => "189" "paginaFinal" => "198" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17305690" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0200" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mechanisms involved in the development of chemotherapy-induced neuropathy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.A. Boyette-Davis" 1 => "E.T. Walters" 2 => "P.M. Dougherty" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2217/pmt.15.19" "Revista" => array:6 [ "tituloSerie" => "Pain Manag" "fecha" => "2015" "volumen" => "5" "paginaInicial" => "285" "paginaFinal" => "296" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26087973" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0205" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The possible involvement of JNK activation in the spinal dorsal horn in bortezomib-induced allodynia: the role of TNF-α and IL-1β" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Z.Y. Li" 1 => "Y.P. Zhang" 2 => "J. Zhang" 3 => "S.B. Zhang" 4 => "D2 Li" 5 => "Z.Z. Huang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00540-015-2077-x" "Revista" => array:6 [ "tituloSerie" => "J Anesth" "fecha" => "2016" "volumen" => "30" "paginaInicial" => "55" "paginaFinal" => "63" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26373954" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0210" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Glycogen synthase kinase 3 is part of the molecular machinery regulating the adaptive response to LPS stimulation in microglial cells" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.A. Ajmone-Cat" 1 => "M.C. D’Urso" 2 => "G. di Blasio" 3 => "M.S. Brignone" 4 => "R. De Simone" 5 => "L. Minghetti" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.bbi.2015.11.012" "Revista" => array:6 [ "tituloSerie" => "Brain Behav Immun" "fecha" => "2016" "volumen" => "55" "paginaInicial" => "225" "paginaFinal" => "235" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26593276" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0215" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neurotoxicity induced by antineoplastic proteasome inhibitors" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Alé" 1 => "J. Bruna" 2 => "X. Navarro" 3 => "E. Udina" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.neuro.2014.02.001" "Revista" => array:6 [ "tituloSerie" => "Neurotoxicology" "fecha" => "2014" "volumen" => "43" "paginaInicial" => "28" "paginaFinal" => "35" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24525285" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0220" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pathobiology of cancer chemotherapy-induced peripheral neuropathy (CIPN)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Y. Han" 1 => "M.T. Smith" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3389/fphar.2013.00156" "Revista" => array:5 [ "tituloSerie" => "Front Pharmacol" "fecha" => "2013" "volumen" => "4" "paginaInicial" => "156" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24385965" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0225" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Peripheral neuropathy during bortezomib treatment of multiple myeloma: a review of recent studies" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G. Cavaletti" 1 => "A.J. Jakubowiak" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3109/10428194.2010.483303" "Revista" => array:6 [ "tituloSerie" => "Leuk Lymphoma" "fecha" => "2010" "volumen" => "51" "paginaInicial" => "1178" "paginaFinal" => "1187" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20497001" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0230" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Vitamin E neuroprotection for cisplatin neuropathy: a randomized, placebo controlled trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Pace" 1 => "D. Giannarelli" 2 => "E. Galiè" 3 => "A. Savarese" 4 => "S. Carpano" 5 => "M. della Giulia" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1212/WNL.0b013e3181d5279e" "Revista" => array:7 [ "tituloSerie" => "Neurology" "fecha" => "2010" "volumen" => "74" "paginaInicial" => "762" "paginaFinal" => "766" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20194916" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S147020451370024X" "estado" => "S300" "issn" => "14702045" ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0235" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Disturbance in ADL from chemotherapy-induced peripheral neuropathy and quality of life in cancer patients: the mediating effect of psychological distress" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "K.Y. Kim" 1 => "S.H. Lee" 2 => "J.H. Kim" 3 => "P.J. Oh" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4040/jkan.2015.45.5.661" "Revista" => array:6 [ "tituloSerie" => "J Korean Acad Nurs" "fecha" => "2015" "volumen" => "45" "paginaInicial" => "661" "paginaFinal" => "670" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26582111" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0240" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chemotherapy-induced peripheral neuropathy and its impact on health-related quality of life among ovarian cancer survivors: results from the population-based PROFILES registry" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N.P. Ezendam" 1 => "B. Pijlman" 2 => "C. Bhugwandass" 3 => "J.F. Pruijt" 4 => "F. Mols" 5 => "M.C. Vos" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ygyno.2014.09.016" "Revista" => array:6 [ "tituloSerie" => "Gynecol Oncol" "fecha" => "2014" "volumen" => "135" "paginaInicial" => "510" "paginaFinal" => "517" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25281491" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0245" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Medical treatment of neuropathic pain" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G. Slapo" 1 => "J. Schjott" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4045/tidsskr.12.0197" "Revista" => array:6 [ "tituloSerie" => "Tidsskr Nor Laegeforen" "fecha" => "2013" "volumen" => "133" "paginaInicial" => "971" "paginaFinal" => "973" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23652147" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0250" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cytokines in neuropathic pain and associated depression" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J.G. Lees" 1 => "B. Fivelman" 2 => "S.S. Duffy" 3 => "P.G. Makker" 4 => "C.J. Perera" 5 => "G. Moalem-Taylor" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Mod Trends Pharmaco Psychiatri" "fecha" => "2015" "volumen" => "30" "paginaInicial" => "51" "paginaFinal" => "66" ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0255" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Falls and functional impairments in cancer survivors with chemotherapy-induced peripheral neuropathy (CIPN): a University of Rochester CCOP study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.S. Gewandter" 1 => "L. Fan" 2 => "A. Magnuson" 3 => "K. Mustian" 4 => "L. Peppone" 5 => "C. Heckler" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00520-013-1766-y" "Revista" => array:6 [ "tituloSerie" => "Support Care Cancer" "fecha" => "2013" "volumen" => "21" "paginaInicial" => "2059" "paginaFinal" => "2066" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23446880" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0260" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The social consequences for older people of neuropathic pain: a qualitative study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "B. Sofaer-Bennett" 1 => "J. Walker" 2 => "A. Moore" 3 => "J. Lamberty" 4 => "T. Thorp" 5 => "J. O’Dwyer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1526-4637.2006.00222.x" "Revista" => array:6 [ "tituloSerie" => "Pain Med" "fecha" => "2007" "volumen" => "8" "paginaInicial" => "263" "paginaFinal" => "270" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17371414" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0265" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The burden associated with neuropathic pain in Western Europe" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "P.C. Langley" 1 => "C. van Litsenburg" 2 => "J.C. Cappelleri" 3 => "D. Carroll" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3111/13696998.2012.729548" "Revista" => array:7 [ "tituloSerie" => "J Med Econ" "fecha" => "2013" "volumen" => "16" "paginaInicial" => "85" "paginaFinal" => "95" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22970839" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S014067361260868X" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0270" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "Available from: <a class="elsevierStyleInterRef" target="_blank" id="intr0015" href="http://www.who.int/iris/handle/10665/37200">http://www.who.int/iris/handle/10665/37200</a> [accessed 13.02.13]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Who handbook for reporting results of cáncer treatment" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Worl Health Organitation (WHO)" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:4 [ "fecha" => "1979" "paginaInicial" => "45" "editorial" => "World Healt Organitation, Who offset publication; no. 48" "editorialLocalizacion" => "Geneva" ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0275" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Linguistic adaptation and Spanish validation of the LANSS (Leeds Assessment of Neuropathic Symptoms and Signs) scale for the diagnosis of neuropathic pain" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C. Pérez" 1 => "R. Gálvez" 2 => "J. Insausti" 3 => "M. Bennet" 4 => "M. Ruiz" 5 => "J. Rejas" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "2006" "volumen" => "127" "paginaInicial" => "485" "paginaFinal" => "491" ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0280" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Validity and reliability of the Spanish version of the DN4 (Douleur Neuropathique 4 questions) questionnaire for differential diagnosis of pain syndromes associated to a neuropathic or somatic component" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C. Perez" 1 => "R. Galvez" 2 => "S. Huelbes" 3 => "J. Insausti" 4 => "D. Bouhassira" 5 => "S. Diaz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1477-7525-5-66" "Revista" => array:5 [ "tituloSerie" => "Health Qual Life Outcomes" "fecha" => "2007" "volumen" => "5" "paginaInicial" => "66" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18053212" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0285" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Validación española del cuestionario Brief Pain Inventory en pacientes con dolor de causa neoplásica" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "X. Badia" 1 => "C. Muriel" 2 => "A. Gracia" 3 => "J.M. Núñez-Olarte" 4 => "N. Perulero" 5 => "R. Gálvez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "2003" "volumen" => "120" "paginaInicial" => "52" "paginaFinal" => "59" "itemHostRev" => array:3 [ "pii" => "S0022202X15371189" "estado" => "S300" "issn" => "0022202X" ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0290" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Adaptación transcultural a la población española de la escala de incapacidad por dolor lumbar de Oswestry" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.T. Flórez García" 1 => "M.A. García Pérez" 2 => "F. García Pérez" 3 => "J. Armenteros Pedreros" 4 => "A. Álvarez Prado" 5 => "M.D. Martínez Lorente" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rehabilitación (Madr)" "fecha" => "1995" "volumen" => "29" "paginaInicial" => "138" "paginaFinal" => "145" ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0295" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Escala de incapacidad por dolor lumbar de Oswestry" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M.T. Alcántara-Bumbiedro" 1 => "C. Flórez-García" 2 => "Echávarri-Pérez" 3 => "F. García-Pérez." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rehabilitación" "fecha" => "2006" "volumen" => "40" "paginaInicial" => "150" "paginaFinal" => "158" ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0300" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Informe técnico de la Agencia de Evaluación de Tecnologías Sanitarias (AETS) del Instituto de Salud Carlos III del Ministerio de Sanidad y Consumo. Índices y escalas utilizados en ciertas tecnologías de la prestación ortoprotésica. Publicación N.° 33 Madrid, noviembre del 2002. Available from: <a id="intr0020" class="elsevierStyleInterRef" href="http://gesdoc.isciii.es/gesdoccontroller?action=download%26id=07/11/2012-c27c8b55c2">http://gesdoc.isciii.es/gesdoccontroller?action=download&id=07/11/2012-c27c8b55c2</a> [accessed 22.11.15]." ] ] ] 27 => array:3 [ "identificador" => "bib0305" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Escalas específicas para la evaluación de la calidad de vida en el ictus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "F.J. Carod-Artal" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Neurol" "fecha" => "2004" "volumen" => "39" "paginaInicial" => "1053" "paginaFinal" => "1055" "itemHostRev" => array:3 [ "pii" => "S0022202X15418123" "estado" => "S300" "issn" => "0022202X" ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0310" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Giraldo P, López L, Palomera L. Guía Clínica y protocolo de actuación en el tratamiento del mieloma múltiple. Utilización de bortezomib (Velcade<span class="elsevierStyleSup">®</span>), mayo del 2005, p. 12. Available from: <a id="intr0025" class="elsevierStyleInterRef" href="http://www.fehha.org/pub/publicaciones/docs/guia_MM.pdf">http://www.fehha.org/pub/publicaciones/docs/guia_MM.pdf</a> [accessed 16.03.14]." ] ] ] 29 => array:3 [ "identificador" => "bib0315" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Small fibre neuropathy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G. Lauria" 1 => "I. Merquies" 2 => "Faber C.G. Review" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/WCO.0b013e32835804c5" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Neurol" "fecha" => "2012" "volumen" => "25" "paginaInicial" => "542" "paginaFinal" => "547" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22941266" "web" => "Medline" ] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0320" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "On the relationship between nociceptive evoked potentials and skin biopsy in small fiber neuropathies" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J. Casanova-Molla" 1 => "J.M. Grau-Junyent" 2 => "M. Morales" 3 => "J. Valls-Solé" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.pain.2010.11.012" "Revista" => array:6 [ "tituloSerie" => "Pain" "fecha" => "2011" "volumen" => "152" "paginaInicial" => "410" "paginaFinal" => "418" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21185650" "web" => "Medline" ] ] ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0325" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bortezomib-induced peripheral neuropathy in multiple myeloma: a comprehensive review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.A. Argyriou" 1 => "G. Iconomou" 2 => "H.P. Kalofonos" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1182/blood-2008-04-149385" "Revista" => array:6 [ "tituloSerie" => "Blood" "fecha" => "2008" "volumen" => "112" "paginaInicial" => "1593" "paginaFinal" => "1599" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18574024" "web" => "Medline" ] ] ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0330" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chemotherapy-induced neuropathy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Bhagra" 1 => "R.D. Rhao" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Curr Oncol Rep" "fecha" => "2007" "volumen" => "9" "paginaInicial" => "290" "paginaFinal" => "299" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17588354" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack336427" "titulo" => "Acknowledgements" "texto" => "<p id="par0160" class="elsevierStylePara elsevierViewall">We would like to thank the patients from the haematology department at Hospital Universitario Joan XXIII in Tarragona for participating in this study.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/21735808/0000003300000001/v1_201803061529/S2173580817301578/v1_201803061529/en/main.assets" "Apartado" => array:4 [ "identificador" => "9491" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original Articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735808/0000003300000001/v1_201803061529/S2173580817301578/v1_201803061529/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173580817301578?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 0 | 4 |
| 2024 October | 26 | 6 | 32 |
| 2024 September | 36 | 13 | 49 |
| 2024 August | 34 | 10 | 44 |
| 2024 July | 23 | 6 | 29 |
| 2024 June | 20 | 5 | 25 |
| 2024 May | 26 | 4 | 30 |
| 2024 April | 26 | 4 | 30 |
| 2024 March | 31 | 4 | 35 |
| 2024 February | 18 | 6 | 24 |
| 2024 January | 28 | 7 | 35 |
| 2023 December | 15 | 6 | 21 |
| 2023 November | 27 | 8 | 35 |
| 2023 October | 36 | 11 | 47 |
| 2023 September | 18 | 4 | 22 |
| 2023 August | 20 | 7 | 27 |
| 2023 July | 27 | 9 | 36 |
| 2023 June | 38 | 7 | 45 |
| 2023 May | 59 | 8 | 67 |
| 2023 April | 50 | 3 | 53 |
| 2023 March | 54 | 5 | 59 |
| 2023 February | 34 | 6 | 40 |
| 2023 January | 55 | 8 | 63 |
| 2022 December | 26 | 7 | 33 |
| 2022 November | 30 | 7 | 37 |
| 2022 October | 32 | 26 | 58 |
| 2022 September | 31 | 20 | 51 |
| 2022 August | 35 | 5 | 40 |
| 2022 July | 20 | 9 | 29 |
| 2022 June | 33 | 4 | 37 |
| 2022 May | 25 | 5 | 30 |
| 2022 April | 34 | 10 | 44 |
| 2022 March | 24 | 13 | 37 |
| 2022 February | 37 | 7 | 44 |
| 2022 January | 55 | 9 | 64 |
| 2021 December | 30 | 13 | 43 |
| 2021 November | 46 | 13 | 59 |
| 2021 October | 40 | 16 | 56 |
| 2021 September | 44 | 22 | 66 |
| 2021 August | 37 | 16 | 53 |
| 2021 July | 29 | 7 | 36 |
| 2021 June | 37 | 12 | 49 |
| 2021 May | 49 | 14 | 63 |
| 2021 April | 112 | 19 | 131 |
| 2021 March | 67 | 7 | 74 |
| 2021 February | 56 | 7 | 63 |
| 2021 January | 60 | 15 | 75 |
| 2020 December | 43 | 9 | 52 |
| 2020 November | 73 | 20 | 93 |
| 2020 October | 43 | 7 | 50 |
| 2020 September | 76 | 12 | 88 |
| 2020 August | 52 | 10 | 62 |
| 2020 July | 29 | 15 | 44 |
| 2020 June | 38 | 9 | 47 |
| 2020 May | 32 | 13 | 45 |
| 2020 April | 21 | 5 | 26 |
| 2020 March | 31 | 8 | 39 |
| 2020 February | 59 | 8 | 67 |
| 2020 January | 24 | 4 | 28 |
| 2019 December | 42 | 4 | 46 |
| 2019 November | 8 | 5 | 13 |
| 2019 October | 22 | 4 | 26 |
| 2019 September | 39 | 6 | 45 |
| 2019 August | 59 | 8 | 67 |
| 2019 July | 59 | 21 | 80 |
| 2019 June | 63 | 45 | 108 |
| 2019 May | 164 | 39 | 203 |
| 2019 April | 67 | 18 | 85 |
| 2019 March | 13 | 12 | 25 |
| 2019 February | 14 | 13 | 27 |
| 2019 January | 15 | 10 | 25 |
| 2018 December | 4 | 11 | 15 |
| 2018 November | 7 | 8 | 15 |
| 2018 October | 15 | 23 | 38 |
| 2018 September | 24 | 5 | 29 |
| 2018 August | 7 | 4 | 11 |
| 2018 July | 6 | 2 | 8 |
| 2018 June | 7 | 1 | 8 |
| 2018 May | 8 | 3 | 11 |
| 2018 April | 29 | 4 | 33 |
| 2018 March | 7 | 3 | 10 |
| 2018 February | 10 | 1 | 11 |
| 2018 January | 2 | 4 | 6 |
| 2017 December | 2 | 6 | 8 |
Show all
