New treatment for pain from peripheral neuropathy after chemotherapy

[JimJimJimJim]

Jim Marshall (not a doctor) said ...

Some chemotherapy treatments cause debilitating pain in between 20 to 40 percent of patients. (Taxotere (docetaxel) is the most common chemotherapy for prostate cancer.)

 

The basic cause of this pain is damage to  nerves, mostly in the parts of the body furtherest from the centre (that is, at the periphery, or edge, of the body). Combining this with "neuro" - nerve and "pathy" - suffering or disease, this condition is called peripheral neuropathy.

 

The symptoms of peripheral neuropathy include tingling, numbness, a shooting or burning sensation and sensitivity to temperature.

 

The men in the study below all reported still having significant neuropathy pain three months after finishing chemotherapy. Half the men in the study below got a drug called duloxetine, while the other half got an identical placebo ("sugar pill").

 

Of those who got duloxetine, 59% reported an improvement in their pain, compared to only 38% of those on the placebo.

 

So, if you are in the unlucky men who experience continuing pain from peripheral neuropathy after chemotherapy, your doctor may consider duloxetine for you.

... end Jim

 

 

JAMA. 2013 Apr 3;309(13):1359-67. doi: 10.1001/jama.2013.2813.

Effect of duloxetine on pain, function, and quality of life among patients with chemotherapy-induced painful peripheral neuropathy: a randomized clinical trial.

Smith EM, Pang H, Cirrincione C, Fleishman S, Paskett ED, Ahles T, Bressler LR, Fadul CE, Knox C, Le-Lindqwister N, Gilman PB,Shapiro CL; Alliance for Clinical Trials in Oncology.

Source

University of Michigan School of Nursing, Room 2151, Ann Arbor, MI 48109, USA. ellenls@umich.edu

Abstract

IMPORTANCE:

There are no known effective treatments for painful chemotherapy-induced peripheral neuropathy.

OBJECTIVE:

To determine the effect of duloxetine, 60 mg daily, on average pain severity.

DESIGN, SETTING, AND PATIENTS:

Randomized, double-blind, placebo-controlled crossover trial at 8 National Cancer Institute (NCI)-funded cooperative research networks that enrolled 231 patients who were 25 years or older being treated at community and academic settings between April 2008 and March 2011. Study follow-up was completed July 2012. Stratified by chemotherapeutic drug and comorbid pain risk, patients were randomized to receive either duloxetine followed by placebo or placebo followed by duloxetine. Eligibility required that patients have grade 1 or higher sensory neuropathy according to the NCI Common Terminology Criteria for Adverse Events and at least 4 on a scale of 0 to 10, representing average chemotherapy-induced pain, after paclitaxel, other taxane, or oxaliplatin treatment.

INTERVENTIONS:

The initial treatment consisted of taking 1 capsule daily of either 30 mg of duloxetine or placebo for the first week and 2 capsules of either 30 mg of duloxetine or placebo daily for 4 additional weeks.

MAIN OUTCOME MEASURES:

The primary hypothesis was that duloxetine would be more effective than placebo in decreasing chemotherapy-induced peripheral neuropathic pain. Pain severity was assessed using the Brief Pain Inventory-Short Form "average pain" item with 0 representing no pain and 10 representing as bad as can be imagined.

RESULTS:

Individuals receiving duloxetine as their initial 5-week treatment reported a mean decrease in average pain of 1.06 (95% CI, 0.72-1.40) vs 0.34 (95% CI, 0.01-0.66) among those who received placebo (P = .003; effect size, 0.513). The observed mean difference in the average pain score between duloxetine and placebo was 0.73 (95% CI, 0.26-1.20). Fifty-nine percent of those initially receiving duloxetine vs 38% of those initially receiving placebo reported decreased painof any amount. CONCLUSION AND RELEVANCE: Among patients with painful chemotherapy-induced peripheral neuropathy, the use of duloxetine compared with placebo for 5 weeks resulted in a greater reduction in pain.

TRIAL REGISTRATION:

clinicaltrials.gov Identifier: NCT00489411.

PMID:23549581