Treatment of Chemotherapy - Induced Peripheral Neuropathy: The Physicians Need Guidelines, the Patients Need Help

• Krzysztof Brzezinsk

  Outpatient Pain Clinic, Institute of Rural Health, ul. Jaczewskiego 2, 20-090 Lublin, Poland

 The aim of the study was to verify the effectiveness of two methods of introducing standard CIPN-treatment drugs into the therapy.

Materials and Methods: Group A included patients attending weekly appointments, while group B monthly. Standard treatment with amitriptyline, gabapentin (GAB), and oxycodone (OXY) was administered. In group A, the drugs were gradually introduced, while in group B - within one week. After a month and six months of treatment, the therapy effectiveness was assessed by examination of pain intensity (VAS), symptoms of peripheral neuropathy (sNCI-CTC), occurrence of tactile and brush allodynia, and the daily dose of GAB andOXY.

Results: Pain intensity during the study decreased from 5.59 to 2.9 and 2.76 in group A, and from 5.07 to 2.52 and 2.81 in group B. The sNCI-CTC values declined too and were, respectively. 1.9; 1.48; 1.34 in group A and 1.93; 1.52; 1.44 in group B. Tactile allodynia occurred in 15; 5; 5 group A patients and 18; 6; 5 group B patients. Brush allodynia decreased in group A (9; 5; 5) and B (11; 6; 5). The daily GAB dose was 0; 951.72; 927.41 in group A and 900.0; 900.0; 1000.0 in group B. The daily OXY dose was 0; 21.72; 22.07 in group A and 20.0; 20.0; 27.04 in group B; a statistically significant difference was found in the final stage.

The results do not allow recommendation of non-schematic treatment and they should be regarded as a preliminary study. Randomized trials are indispensable for assessment of advantages and drawbacks such treatment.

Stannard CF, Kalso E, Ballantyne J. Evidence-based chronic pain management. ISBN: 978-1-4051-5291-4. Wiley-Blackwell 2010.

Dworkin RH, O’Connor AB, Backonja M, et al. Pharmacologic management of neuropathic pain: Evidence-based recommendations. Pain 2007; 13: 2237-251.

Finnerup NB, Otto M, McQuay HJ, Jensen TS, Sindrup SH. Algorithm for neuropathic pain treatment: an evidence based proposal. Pain 2005; 118: 289-305. http://dx.doi.org/10.1016/j.pain.2005.08.013

Finnerup NB, Sindrup SH, Jensen TS. The evidence for pharmacological treatment of neuropathic pain. Pain 2010; 150: 573-81. http://dx.doi.org/10.1016/j.pain.2010.06.019

Dworkin RH, O’Connor AB, Audette J, et al. Recommendations for the pharmacological management of neuropathic pain: an overview and literature update. Mayo Clin Proc 2010; 85(suppl): 3-14. http://dx.doi.org/10.4065/mcp.2009.0649

Blyth FM, March LM, Brnabic AJ, Cousins MJ. Chronic pain and frequent use of health care. Pain 2004; 111(1-2): 51-8. http://dx.doi.org/10.1016/j.pain.2004.05.020

Grad R, Tamblyn R, McLeod PJ, Snell L, Illescas A, Boudreau D. Does knowledge of drug prescribing predict drug management of standardized patients in office practice? Med Educ 1997; 31: 132-7. http://dx.doi.org/10.1111/j.1365-2923.1997.tb02472.x

Dworkin RH, Panarites CJ, Armstrong EP, Malone DC, Pham SV. Is treatment of postherpetic neuralgia in the community consistent with evidence-based recommendations? Pain 2012; 153(4): 869-75. http://dx.doi.org/10.1016/j.pain.2012.01.015

Cruccu G, Attal N. Do clinicians adhere to treatment recommendations for neuropathic pain? Pain 2012; 153(4): 740-1. http://dx.doi.org/10.1016/j.pain.2012.02.019

Vielvoye-Kerkmer A, Mattern C, Uitendaal MP. Transdermal fentanyl in opioid-naive cancer pain patients: an open trial using transdermal fentanyl for the treatment of chronic cancer pain in opioid-naive patients and a group using codeine. J Pain Symptom Manage 2000; 19: 185-92.

Mystakidou K, Befon S, Tsilika E, Dardoufas K, Georgaki S, Vlahos L. Use of TTS fentanyl as a single opioid for cancer pain relief: a safety and efficacy clinical trial in patients naive to mild or strong opioids. Oncology 2002; 62: 9-16. http://dx.doi.org/10.1159/000048241

Mystakidou K, Parpa E, Tsilika E, et al. Pain management of cancer patients with transdermal fentanyl: a study of 1828 step I, II, & III transfers. J Pain 2004; 5: 119-32. http://dx.doi.org/10.1016/j.jpain.2003.12.003

Ripamonti C, Fagnoni E, Campa T, Brunelli C, De Conno F. Is the use of transdermal fentanyl inappropriate according to the WHO guidelines and the EAPC recommendations? A study of cancer patients in Italy. Support Care Cancer 2006; 14: 400-407. http://dx.doi.org/10.1007/s00520-005-0918-0

Windebank AJ, Grisold W. Chemotherapy-induced neuropathy. Journal of the Peripheral Nervous System 2008; 13: 27-46. http://dx.doi.org/10.1111/j.1529-8027.2008.00156.x

Paice JA. Chronic treatment-related pain in cancer survivors. Pain 2011; 152: 84-89. http://dx.doi.org/10.1016/j.pain.2010.10.010

Attal N, Fermanian C, Fermanian J, Lanteri-Minet M, Alchaar H, Bouhassira D. Neuropathic pain: are there distinct subtypes depending on the aetiology or anatomical lesion? Pain 2008; 138: 343-53. http://dx.doi.org/10.1016/j.pain.2008.01.006

Hansson PT, Dickenson AH. Pharmacological treatment of peripheral neuropathic pain conditions based on shared commonalities despite multiple etiologies. Pain 2005; 113: 251-4. http://dx.doi.org/10.1016/j.pain.2004.10.007

Smith EM, Bakitas MA, Homel P, et al. Preliminary assessment of a neuropathic pain treatment and referral algorithm for patients with cancer. J Pain Symptom Manage 2011; 42: 822-38. http://dx.doi.org/10.1016/j.jpainsymman.2011.03.017

Richardson PG, Briemberg H, Jagannath S, et al. Frequency, characteristics, and reversibility of peripheral neuropathy during treatment of advanced multiple myeloma with bortezomib. J Clin Oncol 2006; 24: 3113-20. http://dx.doi.org/10.1200/JCO.2005.04.7779

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