1. Painful peripheral neuropathy is a common side effect of modern chemotherapy regimens.
2. The serotonin and norepinephrine reuptake inhibitor duloxetine significantly reduces neuropathic pain and improves quality of life in patients receiving chemotherapy.
Study Rundown: Peripheral neuropathy is a common side effect of chemotherapy that has proven extremely difficult to treat, despite investigations into a wide range of treatments. The present study presents strong evidence that duloxetine may effectively decrease neuropathic pain in patients receiving two widely-used forms of chemotherapy. Serotonin and norepinephrine are both involved in central suppression of peripheral pain signaling, which may explain the effectiveness of selective serotonin and norepinephrine reuptake inhibitors such as duloxetine.
In terms of limitations, this study was not designed to determine if duloxetine may be more efficacious for a particular chemotherapeutic agent relative to another. While a trend toward greater responsiveness was observed in patients receiving platinum-based drugs, the study was underpowered to confirm this. While future, larger-scale studies will be necessary to elucidate the finer details of duloxetine’s effects, this study provides strong evidence for this drug as a promising therapy for chemotherapy-induced neuropathic pain from paclitaxel, other taxanes or oxaliplatin treatment.
In Depth [double-blind, placebo-controlled crossover study]: Patients receiving either platinum- or taxane-based chemotherapy and experiencing resultant peripheral neuropathy were randomized to receive five weeks of duloxetine or placebo. After a one-week washout period, each group then received five weeks of the alternate therapy. Patients taking other serotonergic medications were excluded from the study. With regards to the primary outcome, patients in the duloxetine-first group reported a significantly larger decrease in average pain scores during the initial trial period (p=0.003). These patients were more likely to report any decrease in pain, as well as to experience 30% and 50% reduction in average pain scores. Moreover, patients in the duloxetine-first group reported significantly greater decrease in functional impairment due to pain (p=0.01), as well as an improvement in pain-related quality of life (p=0.03). Similarly significant results were found in the duloxetine-second group during the final five weeks of the study, though no significant order effect was observed.
By Jeff Dewey and Rif Rahman
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