Local Sympathectomy Promotes Anti-inflammatory Responses and Relief of Paclitaxel-induced Mechanical and Cold Allodynia in Mice

Background: Patients undergoing cancer treatment often experience chemotherapy-induced neuropathic pain at their extremities, for which there is no U.S. Food and Drug Administration-approved drug. The authors hypothesized that local sympathetic blockade, which is used in the clinic to treat various pain conditions, can also be effective to treat chemotherapy-induced neuropathic pain. Methods: A local sympathectomy (i.e., cutting the ipsilateral gray rami entering the spinal nerves near the L3 and L4 dorsal root ganglia) was performed in mice receiving intraperitoneal injections every other day of the chemotherapeutic drug paclitaxel. Sympathectomy effects were then assessed in chemotherapy-induced pain-like behaviors (i.e., mechanical and cold allodynia) and neuroimmune and electrophysiologic responses. Results: Local microsympathectomy produced a fast recovery from mechanical allodynia (mean SD: sympathectomy vs. sham at day 5, 1.07 +/- 0.34g vs. 0.51 +/- 0.17g, n = 5, P = 0.030 in male mice, and 1.08 +/- 0.28g vs. 0.62 +/- 0.16g, n = 5, P = 0.036 in female mice) and prevented the development of cold allodynia in both male and female mice after paclitaxel. Mechanistically, microsympathectomy induced transcriptional increases in dorsal root ganglia of macrophage markers and anti-inflammatory cytokines, such as the transforming growth factor-beta. Accordingly, depletion of monocytes/macrophages and blockade of transforming growth factor-beta signaling reversed the relief of mechanical allodynia by microsympathectomy. In particular, exogenous transforming growth factor-beta was sufficient to relieve mechanical allodynia after paclitaxel (transforming growth factor-beta 100ng/site vs. vehicle at 3h, 1.21 +/- 0.34g vs. 0.53 +/- 0.14g, n = 5, P = 0.001 in male mice), and transforming growth factor-beta signaling regulated neuronal activity in dorsal root ganglia. Conclusions: Local sympathetic nerves control the progression of immune responses in dorsal root ganglia and pain-like behaviors in mice after paclitaxel, raising the possibility that clinical strategies already in use for local sympathetic blockade may also offer an effective treatment for patients experiencing chemotherapy-induced neuropathic pain.