Pilot study of duloxetine for cancer patients with neuropathic pain non-responsive to pregabalin
Department of Medical Oncology, Kinki University Faculty of Medicine, Osaka, Japan. Anticancer research
(Impact Factor: 1.83).
Neuropathic pain frequently occurs in cancer patients, but no drug therapy has been established for this type of disorder. The purpose of this study was to investigate the effect of duloxetine in cancer patients suffering from neuropathic pain.
The subjects of the study were 15 cancer patients with neuropathic pain who visited the Kinki University Faculty of Medicine Hospital and met the International Association for the Study of Pain diagnostic criteria for neuropathic pain. Duloxetine was administered to patients in whom pregabalin could not be administered. The influence of duloxetine was investigated retrospectively with the use of a numerical rating scale.
Pain was reduced in 7 out of the 15 patients. Sleepiness and the light-headed feeling were improved in four patients, in whom, however, the pain was not reduced. Thus, duloxetine was judged to be effective in 11 patients. The maintenance dose of duloxetine was 20-40 mg/day.
Duloxetine administration may be effective for neuropathic pain in cancer patients who cannot tolerate pregabalin administration.
Available from: Eriphili Argyra
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Neuropathic cancer pain (NCP) is a common manifestation of cancer and/or its treatment. Treatment following the WHO analgesic ladder provides relief for the majority of cancer pain patients; however, concern remains that opioids may be less efficacious for neuropathic pain (NP) compared with nociceptive pain, often necessitating the use of higher doses. Adjuvants, such as pregabalin, have shown to be efficacious for the treatment of NP, although data come mostly from noncancer studies. The comparative efficacy and safety of opioids versus adjuvants has not been studied for NCP. The aim of this study was to directly compare pregabalin versus a strong opioid for the treatment of NCP.
A total of 120 patients, diagnosed with "definite" NCP, were randomized into two groups and received increasing doses of either oral pregabalin or transdermal fentanyl for 28 days. VAS score, patient satisfaction, need for opioid rescue, and adverse events (AEs) were recorded.
In the pregabalin group, a significantly higher proportion of patients achieved at least 30% reduction in VAS compared with the fentanyl group (73.3%, 95% CI: 60.3%-83.93 vs. 36.7%, 95% CI: 24.5%-50.1%, P < 0.0001, respectively), while the percentage mean change from baseline was also significantly different [46% (95% CI: 39.5%-52.8%) for pregabalin and 22% (95% CI: 14.9%-29.5%) for fentanyl (P < 0.0001)]. Patient-reported satisfaction was more frequent with pregabalin, while AEs and treatment discontinuations were more frequent in the fentanyl group.
Prompt use of a neuropathic pain-specific adjuvant, such as pregabalin, in NCP may lead to better control of the neuropathic component, with opioid-sparing effects.
Pain Practice 03/2013; 14(1). DOI:10.1111/papr.12045 · 2.36 Impact Factor
Available from: Luigi Grassi
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ABSTRACT: Psychopharmacological intervention is a major clinical and research area in oncology and palliative care. Over the last 35 years, psychotropic drugs have been shown to have a number of important indications for the treatment of the most common psychiatric disorders, such as depression, anxiety, stress-related syndromes, severe adjustment disorders, sleep disorders and delirium, which combined affect at least 30-40% of patients with cancer and even a higher percentage of patients in an advanced phase of illness. The availability of new drugs, with less side-effects and safer pharmacological profiles, has been a major advance in clinical psycho-oncology. Interestingly, several drugs have also been found to be helpful for the adjuvant treatment of cancer-related symptoms, such as pain, hot flashes, pruritus, nausea and vomiting, fatigue, and cognitive impairment, making psychopharmacology an important tool for the improvement of cancer patients' quality of life. The aim of this paper is to summarize recent relevant data concerning the use of psychotropic drugs, namely antidepressants, anxiolytics, antipsychotics, anticonvulsants and psychostimulants in patients with cancer.
Current Psychiatry Reports 09/2013; 15(9):393. DOI:10.1007/s11920-013-0393-0 · 3.24 Impact Factor
09/2013; 4(5):361-8. DOI:10.6004/jadpro.2013.4.5.8
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