Haematological indices as markers of neuropathic pain in Nigerian cancer patients: a cross-sectional study

Abstract

Aim: Neuropathic pain (NP) is common in cancer patients, but its relationship with haematological inflammatory markers remains poorly understood. This study explored the association between NP and haematological parameters in Nigerian cancer patients.

Methods: This cross-sectional study enrolled 90 patients with solid tumours from the University of Ilorin Teaching Hospital. Pain severity was assessed using the Numerical Rating Scale, while NP was evaluated with the painDETECT questionnaire. Complete blood count parameters were analysed, and derived inflammatory indices were calculated. Statistical analyses employed chi-square tests, Spearman’s correlation, and binary logistic regression.

Results: NP was present in 21.1% of patients. Significant associations with NP were observed for haemoglobin (p = 0.006), absolute lymphocyte count (p = 0.003), platelet-to-lymphocyte ratio (PLR, p = 0.015), haemoglobin-to-platelet ratio (HPR, p = 0.001), and systemic immune-inflammation index (SII, p < 0.001). Correlation analysis showed NP positively correlated with platelet count (ρ = 0.23, p = 0.029), absolute neutrophil count (ρ = 0.263, p = 0.012), neutrophil-to-lymphocyte ratio (NLR, ρ = 0.248, p = 0.019), SII (ρ = 0.215, p = 0.045), and neutrophil-platelet score (NPS, ρ = 0.248, p = 0.018), while correlating negatively with haemoglobin (ρ = –0.223, p = 0.034). Logistic regression identified haemoglobin, platelet count, absolute lymphocyte count, absolute neutrophil count, NLR, and HPR as independent predictors of NP.

Conclusions: Haematological parameters reflecting systemic inflammation are significantly associated with NP in cancer patients. These readily available indices may serve as useful adjuncts for identifying at-risk patients, particularly in resource-limited settings. Prospective studies are warranted to validate these findings.

Keywords

inflammation / neuropathic pain / haematological indices / cancer / biomarkers

References

[1] Macharia JM, Raposa BL, Sipos D, Melczer C, Toth Z, Káposztás Z. The Impact of Palliative Care on Mitigating Pain and Its Associated Effects in Determining Quality of Life among Colon Cancer Outpatients. Healthcare. 2023; 11:2954.

[2] Edwards HL, Mulvey MR, Bennett MI. Cancer-Related Neuropathic Pain. Cancers. 2019; 11:373.

[3] Maihöfner C, Diel I, Tesch H, Quandel T, Baron R. Chemotherapy-induced peripheral neuropathy (CIPN): current therapies and topical treatment option with high-concentration capsaicin. Support Care Cancer. 2021; 29:4223-38.

[4] Izuegbuna O, Kolawole I, Oguntola S, Woods-Ali T, Saburi O, Adindu CC, et al.Prevalence and factors associated with cancer-related neuropathic pain among cancer patients in Nigeria—a single-center cross-sectional study. Pain Manag. 2025; 15:251-8.

[5] Orhurhu MS, Chu R, Claus L, Roberts J, Salisu B, Urits I, et al.Neuropathic Pain and Sickle Cell Disease: a Review of Pharmacologic Management. Curr Pain Headache Rep. 2020; 24:52.

[6] Sandy-Hindmarch O, Bennett DL, Wiberg A, Furniss D, Baskozos G, Schmid AB. Systemic inflammatory markers in neuropathic pain, nerve injury, and recovery. Pain. 2021; 163:526-37.

[7] Liu F, Zhang L, Su S, Fang Y, Yin XS, Cui H, et al.Neuronal C‐Reactive Protein/Fc γ RI Positive Feedback Proinflammatory Signaling Contributes to Nerve Injury Induced Neuropathic Pain. Adv Sci. 2023; 10:e2205397.

[8] Cosma-Lăzuran R, Leucuta DC, Popoviciu MS. Systemic Immune-Inflammation Index and Related Hematologic Markers as Prognostic Tools in Type 2 Diabetes. Medicina. 2025; 61:1433.

[9] Izuegbuna O, Olawumi H, Olatoke S, Agodirin O. Haemogram Pattern and Khorana Score of Breast Cancer Patients in A Tertiary Centre in Nigeria. Tanzan Med J. 2020; 31:110-31.

[10] Aiholli S, Adya KA, Inamadar AC. Role of Hematological Indices as Predictors of Systemic Inflammation in Dermatology. Indian Dermatol Online J. 2023; 15:188-95.

[11] Wu Y, Huang Y, Wu Y, Sun J, Xie Q, Yin G. Systemic immune-inflammation index as a versatile biomarker in autoimmune disorders: insights from rheumatoid arthritis, lupus, and spondyloarthritis. Front Immunol. 2025; 16:1621209.

[12] Rizzo A, Vitale E, Maistrello L, Santa K, Santoni M. Association Between Systemic Immune-Inflammatory Index (SII) and Cancer Grading and Staging: Evidence from the Current Scientific Literature. Biology. 2026; 15:253.

[13] Watt DG, Proctor MJ, Park JH, Horgan PG, McMillan DC. The Neutrophil-Platelet Score (NPS) Predicts Survival in Primary Operable Colorectal Cancer and a Variety of Common Cancers. PLoS ONE. 2015; 10:e0142159.

[14] Irawan C, Rachman A, Rahman P, Mansjoer A. Role of Pretreatment Hemoglobin-to-Platelet Ratio in Predicting Survival Outcome of Locally Advanced Nasopharyngeal Carcinoma Patients. J Cancer Epidemiol. 2021; 2021:1103631.

[15] Huerta MÁ, Molina-Álvarez M, García MM, Tejada MA, Goicoechea C, Ghasemlou N, et al.The role of neutrophils in pain: systematic review and meta-analysis of animal studies. Pain. 2024; 166:1230-49.

[16] Schomberg D, Ahmed M, Miranpuri G, Olson J, Resnick DK. Neuropathic pain: role of inflammation, immune response, and ion channel activity in central injury mechanisms. Ann Neurosci. 2012; 19:125-32.

[17] Bhagat S, Munshi SA, Palanivelu SV. The Overlooked Role of Iron Deficiency in Neuropathic Pain: A Case Report and Review. Indian J Pain. 2025; 40:30-2.

[18] Natalucci V, Virgili E, Calcagnoli F, Valli G, Agostini D, Zeppa SD, et al.Cancer Related Anemia: An Integrated Multitarget Approach and Lifestyle Interventions. Nutrients. 2021; 13:482.

[19] Bennett MI, Rayment C, Hjermstad M, Aass N, Caraceni A, Kaasa S. Prevalence and aetiology of neuropathic pain in cancer patients: A systematic review. Pain. 2012; 153:359-65.

[20] Snijders RAH, Brom L, Theunissen M, van den Beuken-van Everdingen MHJ. Update on Prevalence of Pain in Patients with Cancer 2022: A Systematic Literature Review and Meta-Analysis. Cancers. 2023; 15:591.

[21] Wen B, Pan Y, Cheng J, Xu L, Xu J. The Role of Neuroinflammation in Complex Regional Pain Syndrome: A Comprehensive Review. J Pain Res. 2023; 16:3061-73.

[22] Sommer C, Leinders M, Üçeyler N. Inflammation in the pathophysiology of neuropathic pain. Pain. 2017; 159:595-602.

[23] Caxaria S, Bharde S, Fuller AM, Evans R, Thomas B, Celik P, et al.Neutrophils infiltrate sensory ganglia and mediate chronic widespread pain in fibromyalgia. Proc Natl Acad Sci. 2023; 120:e2211631120.

[24] Balog BM, Sonti A, Zigmond RE. Neutrophil biology in injuries and diseases of the central and peripheral nervous systems. Prog Neurobiol. 2023; 228:102488.

[25] Jia SY, Tang XJ, Su Y, Liu YN, Ming Z, Lin JY. The role and mechanisms of matrix metalloproteinase-9 in peripheral neuropathic pain. Front Mol Neurosci. 2025; 18:1647316.

[26] Anjum A, Lokanathan Y. Balancing inflammation and regeneration: immune cell dynamics in nerve repair: a comprehensive review. Inflamm Res. 2026; 75:e75.

[27] Ding K, Liu X, Zeng B, Liu S, Zhang L, Li B, et al.Exploring the role of neutrophils in inflammatory pain hypersensitivity via single-cell transcriptome profiling. Front Immunol. 2025; 16:1552993.

[28] Ishihara M, Chen H, Asaga R, Suzuki H, Yamamoto S, Kawamoto M, et al.Prognostic Impact of Baseline Neutrophil-to-Lymphocyte Ratio and Its On-Treatment Change on Survival Outcomes in Advanced Small-Cell Lung Cancer: A Retrospective Analysis. Cancers. 2026; 18:671.

[29] Yang MJ, Kim S, Hwang JC, Jung W, Park SH, Heo SM, et al.High Neutrophil‐to‐Lymphocyte Ratio Predicts a Suppressive Immune Microenvironment and Basal‐Like Subtype in Pancreatic Cancer. J Gastroenterol Hepatol. 2025; 40:2623-31.

[30] Zandi A, Qian A, Othman M. Optimal Cutoff for the Neutrophil-to-Lymphocyte Ratio as a Tool for Pre-chemotherapy Prognosis Stratification of Breast Cancer Patients. Cureus. 2025; 17:e90705.

[31] Rawish E, Nording H, Münte T, Langer HF. Platelets as Mediators of Neuroinflammation and Thrombosis. Front Immunol. 2020; 11:548631.

[32] Horstman LL, Jy W, Ahn YS, Zivadinov R, Maghzi AH, Etemadifar M, et al.Role of platelets in neuroinflammation: a wide-angle perspective. J Neuroinflammation. 2010; 7:10.

[33] Morrell CN, Aggrey AA, Chapman LM, Modjeski KL. Emerging roles for platelets as immune and inflammatory cells. Blood. 2014; 123:2759-67.

[34] Lin RJ, Afshar-Kharghan V, Schafer AI. Paraneoplastic thrombocytosis: the secrets of tumor self-promotion. Blood. 2014; 124:184-7.

[35] SUNDARITA E, ALVIANTO S, WIDJANARKO ND, PRAYOGO DL. Systemic Immune-Inflammation Index and Prognostic Outcome of Breast Cancer: An Updated Systematic Review and Meta-Analysis. J Oncol Sci. 2025

[36] Fukushima T, Nakano J, Ishii S, Natsuzako A, Kawachi H, Sakamoto J, et al.Influence of Hemoglobin Level on Muscle and Physical Functions, Activities of Daily Living, and Quality of Life in Patients With Hematological Malignancies. Integr Cancer Ther. 2019; 18:1534735419842196.

[37] Lanser L, Fuchs D, Kurz K, Weiss G. Physiology and Inflammation Driven Pathophysiology of Iron Homeostasis—Mechanistic Insights into Anemia of Inflammation and Its Treatment. Nutrients. 2021; 13:3732.

[38] Zeilfelder A, Vanlier J, Mölders C, Kastl P, Helm B, Burbano de Lara S, et al.Diclofenac and acetaminophen dim the acute-phase response but amplify expression of the iron regulator hepcidin in liver cancer cells. Cell Syst. 2025; 16:101431.