A Multi-Center Cohort Study on Characteristics of Pain, Its Impact and Pharmacotherapeutic Management in Patients with ALS

Background: Although pain is common in amyotrophic lateral sclerosis (ALS) and an effectively treatable symptom, it is widely under-recognized and undertreated. This study investigates epidemiological and clinical characteristics of pain, its impact and pharmacological treatment in ALS patients. In addition, opportunities for further optimization of pain therapy need to be identified. Methods: Patients from three German ALS outpatient clinics were asked to complete the Brief Pain Inventory and the ALS Functional Rating Scale—Extension and to participate in semi-structured telephone interviews. Results: Of the 150 study participants, 84 patients reported pain. Pain occurred across all disease stages, predominantly in the neck, back and lower extremities. It was described with a broad spectrum of pain descriptors and mostly interfered with activity-related functions. Of the 84 pain patients, 53.8% reported an average pain intensity ≥4 on the numerical rating scale (NRS), indicating pain of at least moderate intensity, and 64.3% used pain medication. Irrespective of the medication type, 20.4% of them had no sufficient pain relief. Thirteen out of 30 patients without pain medication reported an average NRS value ≥4. Eleven of them—mainly in the context of high pain interference with daily functions—were supposed to benefit from adequate pain therapy. However, many patients had relevant concerns and misconceptions about pain therapy. Conclusion: Given the frequency, extent and multi-faceted impact of pain, it is necessary to systematically assess pain throughout the disease course. Potentials to optimize pain therapy were seen in the subset of patients with insufficient pain relief despite medication and in those patients without pain medication but high pain interference. However, there is a need to respond to patients’ barriers to pain therapy.

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Clinical Effectiveness and Cost-effectiveness of Videoconference-Based Integrated Cognitive Behavioral Therapy for Chronic Pain: Randomized Controlled Trial (Preprint)

10.2196/preprints.30690 ◽

2021 ◽

Author(s):

Kayoko Taguchi ◽

Noriko Numata ◽

Rieko Takanashi ◽

Ryo Takemura ◽

Tokiko Yoshida ◽

...

Keyword(s):

Chronic Pain ◽

Cognitive Behavioral Therapy ◽

Pain Intensity ◽

Rating Scale ◽

Numerical Rating Scale ◽

Behavioral Therapy ◽

Controlled Trial ◽

Brief Pain Inventory ◽

Cognitive Behavioral ◽

Pain Interference

BACKGROUND Cognitive behavioral therapy is known to improve the management of chronic pain. However, the components of this therapy are still being investigated and debated. OBJECTIVE This study aimed to examine the effectiveness of an integrated cognitive behavioral therapy program with new components (attention-shift, memory work, video feedback, and image training) delivered via videoconferencing. METHODS This study was unblinded and participants were recruited and assessed face-to-face in the outpatient department. We conducted a randomized controlled trial for chronic pain to compare 16 weekly videoconference-based cognitive behavioral therapy (vCBT) sessions provided by a therapist with treatment as usual (TAU). Thirty patients (age range, 22-75 years) with chronic pain were randomly assigned to either vCBT (n=15) or TAU (n=15). Patients were evaluated at week 1 (baseline), week 8 (midintervention), and week 16 (postintervention). The primary outcome was the change in pain intensity, which was recorded using the numerical rating scale at 16 weeks from the baseline. Secondary outcomes were pain severity and pain interference, which were assessed using the Brief Pain Inventory. Additionally, we evaluated disability, pain catastrophizing cognition, depression, anxiety, quality of life, and cost utility. RESULTS In the eligibility assessment, 30 patients were eventually randomized and enrolled; finally, 15 patients in the vCBT and 14 patients in the TAU group were analyzed. Although no significant difference was found between the 2 groups in terms of changes in pain intensity by the numerical rating scale scores at week 16 from baseline (P=.36), there was a significant improvement in the comprehensive evaluation of pain by total score of Brief Pain Inventory (–1.43, 95% CI –2.49 to –0.37, df=24; P=.01). Further, significant improvement was seen in pain interference by using the Brief Pain Inventory (–9.42, 95% CI –14.47 to –4.36, df=25; P=.001) and in disability by using the Pain Disability Assessment Scale (–1.95, 95% CI –3.33 to –0.56, df=24; P=.008) compared with TAU. As for the Medical Economic Evaluation, the incremental cost-effectiveness ratio for 1 year was estimated at 2.9 million yen (about US $25,000) per quality-adjusted life year gained. CONCLUSIONS The findings of our study suggest that integrated cognitive behavioral therapy delivered by videoconferencing in regular medical care may reduce pain interference but not pain intensity. Further, this treatment method may be cost-effective, although this needs to be further verified using a larger sample size. CLINICALTRIAL University Hospital Medical Information Network UMIN000031124; https://tinyurl.com/2pr3xszb

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Clinical Effectiveness and Cost-effectiveness of Videoconference-Based Integrated Cognitive Behavioral Therapy for Chronic Pain: Randomized Controlled Trial

Journal of Medical Internet Research ◽

10.2196/30690 ◽

2021 ◽

Vol 23 (11) ◽

pp. e30690

Author(s):

Kayoko Taguchi ◽

Noriko Numata ◽

Rieko Takanashi ◽

Ryo Takemura ◽

Tokiko Yoshida ◽

...

Keyword(s):

Chronic Pain ◽

Cognitive Behavioral Therapy ◽

Pain Intensity ◽

Rating Scale ◽

Numerical Rating Scale ◽

Behavioral Therapy ◽

Controlled Trial ◽

Brief Pain Inventory ◽

Cognitive Behavioral ◽

Pain Interference

Background Cognitive behavioral therapy is known to improve the management of chronic pain. However, the components of this therapy are still being investigated and debated. Objective This study aimed to examine the effectiveness of an integrated cognitive behavioral therapy program with new components (attention-shift, memory work, video feedback, and image training) delivered via videoconferencing. Methods This study was unblinded and participants were recruited and assessed face-to-face in the outpatient department. We conducted a randomized controlled trial for chronic pain to compare 16 weekly videoconference-based cognitive behavioral therapy (vCBT) sessions provided by a therapist with treatment as usual (TAU). Thirty patients (age range, 22-75 years) with chronic pain were randomly assigned to either vCBT (n=15) or TAU (n=15). Patients were evaluated at week 1 (baseline), week 8 (midintervention), and week 16 (postintervention). The primary outcome was the change in pain intensity, which was recorded using the numerical rating scale at 16 weeks from the baseline. Secondary outcomes were pain severity and pain interference, which were assessed using the Brief Pain Inventory. Additionally, we evaluated disability, pain catastrophizing cognition, depression, anxiety, quality of life, and cost utility. Results In the eligibility assessment, 30 patients were eventually randomized and enrolled; finally, 15 patients in the vCBT and 14 patients in the TAU group were analyzed. Although no significant difference was found between the 2 groups in terms of changes in pain intensity by the numerical rating scale scores at week 16 from baseline (P=.36), there was a significant improvement in the comprehensive evaluation of pain by total score of Brief Pain Inventory (–1.43, 95% CI –2.49 to –0.37, df=24; P=.01). Further, significant improvement was seen in pain interference by using the Brief Pain Inventory (–9.42, 95% CI –14.47 to –4.36, df=25; P=.001) and in disability by using the Pain Disability Assessment Scale (–1.95, 95% CI –3.33 to –0.56, df=24; P=.008) compared with TAU. As for the Medical Economic Evaluation, the incremental cost-effectiveness ratio for 1 year was estimated at 2.9 million yen (about US $25,000) per quality-adjusted life year gained. Conclusions The findings of our study suggest that integrated cognitive behavioral therapy delivered by videoconferencing in regular medical care may reduce pain interference but not pain intensity. Further, this treatment method may be cost-effective, although this needs to be further verified using a larger sample size. Trial Registration University Hospital Medical Information Network UMIN000031124; https://tinyurl.com/2pr3xszb

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Comparing the efficacy of nebulized morphine with intravenous morphine in traumatic musculoskeletal pain management

Journal of Research in Clinical Medicine ◽

10.34172/jrcm.2020.021 ◽

2020 ◽

Vol 8 (1) ◽

pp. 21-21

Author(s):

Mani Mofidi ◽

Ali Dashti ◽

Mahdi Rezai ◽

Niloufar Ghodrati ◽

Hoorolnesa Ameli ◽

...

Keyword(s):

Pain Management ◽

Pain Relief ◽

Musculoskeletal Pain ◽

Normal Saline ◽

Rating Scale ◽

Numerical Rating Scale ◽

Vital Signs ◽

Categorical Variables ◽

Intravenous Morphine ◽

Numerical Rating

Introduction: This study was designed to compare the effectiveness of intravenous morphine with nebulized morphine in pain relief of patients referring to the emergency setting with traumatic musculoskeletal pain. Methods: This randomized, placebo-controlled and double-blind clinical study evaluated 160 patients 18 to 65 years of age with acute traumatic pain, who attended the emergency department during 2019. Subjects were assessed with Numerical Rating Scale based on inclusion and exclusion criteria and randomly divided into two groups. In one group, 80 patients received IV morphine (0.1 mg/kg+5 mL normal saline) plus an equivalent volume of IV placebo. In the second group, 80 patients received nebulized morphine (0.2 mg/kg+5 mL normal saline) plus nebulized placebo. Pain score was monitored in all patients with Numerical Rating Scale before and after intervention at baseline, 15, 30, 45, and 60-minute intervals. Patients’ vital signs and possible adverse events were evaluated in each observation time points. Finally, all participants were assessed for their satisfaction with pain management. Data were analyzed using repeated measure analysis for continuous variables and Binomial test for categorical variables Results: There was no significant difference between the demographic characteristics of patients in study groups. Pain relief between the two groups was similar during the observation (0, 15, 30, 45, 60 min) (P>0.05). There were no changes in vital signs between two groups, although the nebulized group had lower systolic blood pressure at the time-point of 15 minutes after the treatment initiation (P=0.03). Conclusion: Although Nebulized morphine has similar efficacy in comparison with IV route, nebulization might be considered as the clinically efficacious route of morphine administration with minimal side effects, providing optimal pain relief in patients.

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Differential response to scrambler therapy by neuropathic pain phenotypes

Scientific Reports ◽

10.1038/s41598-021-89667-6 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Young Gi Min ◽

Hyun Seok Baek ◽

Kyoung-Min Lee ◽

Yoon-Ho Hong

Keyword(s):

Neuropathic Pain ◽

Treatment Outcome ◽

Rating Scale ◽

Numerical Rating Scale ◽

Brief Pain Inventory ◽

Differential Response ◽

Open Label ◽

Numerical Rating ◽

Scrambler Therapy ◽

Post Hoc

AbstractScrambler therapy is a noninvasive electroanalgesia technique designed to remodulate the pain system. Despite growing evidence of its efficacy in patients with neuropathic pain, little is known about the clinical factors associated with treatment outcome. We conducted a prospective, open-label, single-arm trial to assess the efficacy and safety of scrambler therapy in patients with chronic neuropathic pain of various etiologies. A post-hoc analysis was performed to investigate whether cluster analysis of the Neuropathic Pain Symptom Inventory (NPSI) profiles could identify a subgroup of patients regarding neuropathic pain phenotype and treatment outcome. Scrambler therapy resulted in a significant decrease in the pain numerical rating scale (NRS) score over 2 weeks of treatment (least squares mean of percentage change from baseline, − 15%; 95% CI − 28% to − 2.4%; p < 0.001). The mean score of Brief Pain Inventory (BPI) interference subdimension was also significantly improved (p = 0.022), while the BPI pain composite score was not. Hierarchical clustering based on the NPSI profiles partitioned the patients into 3 clusters with distinct neuropathic pain phenotypes. Linear mixed-effects model analyses revealed differential response to scrambler therapy across clusters (p = 0.003, pain NRS; p = 0.072, BPI interference subdimension). Treatment response to scrambler therapy appears different depending on the neuropathic pain phenotypes, with more favorable outcomes in patients with preferentially paroxysmal pain rather than persistent pain. Further studies are warranted to confirm that capturing neuropathic pain phenotypes can optimize the use of scrambler therapy.

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Acupuncture for Low Back Pain in Pregnancy – a Prospective, Quasi- Randomised, Controlled Study

Acupuncture in Medicine ◽

10.1136/aim.22.2.60 ◽

2004 ◽

Vol 22 (2) ◽

pp. 60-67 ◽

Cited By ~ 36

Author(s):

João Bosco Guerreiro da Silva ◽

Mary Uchiyama Nakamura ◽

José Antonio Cordeiro ◽

Luiz Kulay

Keyword(s):

Pelvic Pain ◽

Rating Scale ◽

Numerical Rating Scale ◽

Real Life ◽

Acupuncture Group ◽

Controlled Study ◽

Control Group ◽

Study Group ◽

Low Back ◽

Average Pain

This study was undertaken to investigate the effects of acupuncture in low back and pelvic pain during pregnancy under real life conditions, as compared with patients undergoing conventional treatment alone. A total of 61 conventionally treated pregnant women were allocated randomly into two groups to be treated or not by acupuncture. Twenty-seven patients formed the study group and 34 the control group. They reported the severity of pain using a Numerical Rating Scale from 0 to 10, and their capacity to perform general activities, to work, and to walk. We also assessed the use of analgesic drugs. Women were followed up for eight weeks and interviewed five times, at two-week intervals. All women completed the study. In the study group the average pain during the study period showed a larger reduction (4.8 points) than the control group (−0.3 points) (P<0.0001). Average pain scores decreased by at least 50% over time in 21 (78%) patients in the acupuncture group and in five (15%) patients in the control group (P<0.0001). Maximum pain and pain at the moment of interview were also less in the acupuncture group compared with the control group. The capacity to perform general activities, to work and to walk was improved significantly more in the study group than in the control group (P<0.05). The use of paracetamol was lower in the acupuncture group (P<0.01). These results indicate that acupuncture seems to alleviate low back and pelvic pain during pregnancy, as well as to increase the capacity for some physical activities and to diminish the need for drugs, which is a great advantage during this period.

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A Pilot Randomized Sham-Controlled Trial of MC5-A Scrambler Therapy in the Treatment of Chronic Chemotherapy-Induced Peripheral Neuropathy (CIPN)

Journal of Palliative Care ◽

10.1177/0825859719827589 ◽

2019 ◽

Vol 35 (1) ◽

pp. 53-58 ◽

Cited By ~ 6

Author(s):

Thomas J. Smith ◽

A. Rab Razzak ◽

Amanda L. Blackford ◽

Jennifer Ensminger ◽

Catherine Saiki ◽

...

Keyword(s):

Peripheral Neuropathy ◽

Rating Scale ◽

Small Sample Size ◽

Controlled Trial ◽

Brief Pain Inventory ◽

Small Sample ◽

Sham Treatment ◽

The Real ◽

Average Pain ◽

Scrambler Therapy

Background: Chemotherapy-induced peripheral neuropathy (CIPN) affects 30% to 40% of patients with cancer with long-lasting disability. Scrambler therapy (ST) appeared to benefit patients in uncontrolled trials, so we performed a randomized sham-controlled Phase II trial of ST. Methods: The primary end point was “average pain” after 28 days on the Numeric Rating Scale. Each received ten 30-minute sessions of ST on the dermatomes above the painful areas, or sham treatment on the back, typically at L3-5 where the nerve roots would enter the spinal cord. Outcomes included the Brief Pain Inventory (BPI)-CIPN and the EORTC CIPN-20 scale. Patients were evaluated before treatment (day 0), day 10, and days 28, 60, and 90. Results: Data regarding pain as a primary outcome were collected for 33 of the 35 patients. There were no significant differences between the sham and the “real” ST group at day 10, 28, 60, or 90, for average pain, the BPI, or EORTC CIPN-20. Individual responses were noted during the ST treatment on the real arm, but most dissipated by day 30. There was improvement in the sensory subscale of the CIPN-20 at 2 months in the “real” group ( P = .14). All “real” patients wanted to continue treatment if available. Discussion: We observed no difference between sham and real ST CIPN treatment. Potential reasons include at least the following: ST does not work; the sham treatment had some effect; small sample size with heterogeneous patients; misplaced electrodes on an area of nonpainful but damaged nerves; or a combination of these factors.

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Postendodontic Pain after Pulpotomy or Root Canal Treatment in Mature Teeth with Carious Pulp Exposure: A Multicenter Randomized Controlled Trial

Pain Research and Management ◽

10.1155/2020/5853412 ◽

2020 ◽

Vol 2020 ◽

pp. 1-14

Author(s):

Mohammad Jafar Eghbal ◽

Ali Haeri ◽

Arash Shahravan ◽

Ali Kazemi ◽

Fariborz Moazami ◽

...

Keyword(s):

Postoperative Pain ◽

Pain Relief ◽

Root Canal ◽

Rating Scale ◽

Numerical Rating Scale ◽

Controlled Trial ◽

Mineral Trioxide Aggregate ◽

Preoperative Pain ◽

Multicenter Randomized Controlled Trial ◽

The Mean

This equivalence, randomized, clinical trial aimed to compare the postoperative pain of root canal therapy (RCT) with pulpotomy with mineral trioxide aggregate (PMTA) or calcium-enriched mixture (PCEM) in permanent mature teeth. In seven academic centers, 550 cariously exposed pulps were included and randomly allocated into PMTA (n = 188), PCEM (n = 194), or RCT (n = 168) arms. Preoperative “Pain Intensity” (PI) on Numerical Rating Scale and postoperative PIs until day 7 were recorded. Patients’ demographic and pre-/intra-/postoperative factors/conditions were recorded/analysed. The arms were homogeneous in terms of demographics. The mean preoperative PIs were similar (P=0.998), the mean sum PIs recorded during 10 postoperative intervals were comparable (P=0.939), and the trend/changes in pain relief were parallel (P=0.821) in all study arms. The incidences of preoperative moderate-severe pain in RCT, PMTA, and PCEM arms were 56.5%, 55.7%, and 56.7%, which after 24 hours considerably decreased to 13.1%, 10.6%, and 12.9%, respectively (P=0.578). The time span of endodontic procedures was statistically different; RCT = 69.73, PMTA = 35.37, and PCEM = 33.62 minutes (P<0.001). Patients with greater preoperative pain, symptomatic apical periodontitis, or presence of PDL widening suffered more pain (P=0.002, 0.035, and 0.023, resp.); however, other pre-/intra-/postoperative factors/conditions were comparable. Pulpotomy with MTA/CEM and RCT demonstrate comparable and effective postoperative pain relief.

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Tailoring of neurosurgical ablative procedures in the management of refractory cancer pain

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2020-101566 ◽

2020 ◽

Vol 45 (9) ◽

pp. 696-701

Author(s):

Uri Hochberg ◽

Asaf Berger ◽

Miri Atias ◽

Rotem Tellem ◽

Ido Strauss

Keyword(s):

Pain Relief ◽

Cancer Pain ◽

Rating Scale ◽

Numerical Rating Scale ◽

Treatment Plan ◽

Metastatic Cancer ◽

Spinothalamic Tract ◽

Pain Syndromes ◽

Intractable Cancer Pain ◽

Ablative Procedures

IntroductionNeurosurgical ablative procedures can offer immediate and effective pain relief for patients suffering from refractory cancer pain. However, choosing the appropriate procedure for each patient may not be straightforward and warrants an interdisciplinary approach. The purpose of the current study was to evaluate the outcome of patients with cancer who were carefully selected for neurosurgical intervention by a dedicated interdisciplinary team composed of a palliative physician and nurse practitioner, a pain specialist and a neurosurgeon.MethodsA retrospective review was carried out on all patients who underwent neurosurgical ablative procedures in our institute between March 2015 and September 2019. All patients had advanced metastatic cancer with unfavorable prognosis and suffered from intractable oncological pain. Each treatment plan was devised to address the patients’ specific pain syndromes.ResultsA total of 204 patients were examined by our service during the study period. Sixty-four patients with localized pain and nineteen patients with diffuse pain syndromes were selected for neurosurgical interventions, either targeted disconnection of the spinothalamic tract or stereotactic cingulotomy. Substantial pain relief was reported by both groups immediately (cordotomy: Numerical Rating Scale (NRS) 9 ≥1, p=0.001, cingulotomy: NRS 9 ≥2, p=0.001) and maintained along the next 3-month follow-up visits.ConclusionsAn interdisciplinary collaboration designated to provide neurosurgical ablative procedures among carefully selected patients could culminate in substantial relief of intractable cancer pain.Trial registration numberIR0354-17.

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Nebulized morphine for analgesia in an emergency setting

Journal of Opioid Management ◽

10.5055/jom.2009.0003 ◽

2018 ◽

Vol 5 (1) ◽

pp. 23 ◽

Cited By ~ 4

Author(s):

Vincent Bounes, MD ◽

Jean Louis Ducassé, MD ◽

Annie Momo Bona, MD ◽

Florent Battefort, MD ◽

Charles-Henri Houze-Cerfon, MD ◽

...

Keyword(s):

Pain Relief ◽

Acute Pain ◽

Rating Scale ◽

Numerical Rating Scale ◽

Statistical Significance ◽

A Priori ◽

Primary Outcome Measure ◽

Point Estimate ◽

Emergency Setting ◽

Significant Difference

Objective: To evaluate the efficacy and safety of inhaled morphine delivered in patients experiencing severe acute pain in an emergency setting.Patients and Methods: Patients were eligible for inclusion if they were aged 18 years or older, with a severe acute pain defined by a numerical rating scale (NRS) score of 60/100 or higher. The intervention involved administering a single dose of 0.2 mg/kg morphine nebulized using a Misty-Neb nebulizer system. NRSs were recorded and were repeated at 1, 3, 5, and 10 minute after the end of inhalation (T10). The protocol-defined primary outcome measure was pain relief (defined by an NRS score of 30/100 or lower) at T10. Secondary outcomes included differences between pain scores at baseline and at T10 and incidence of adverse events.Results: A total of 28 patients were included in this study. No patient experienced pain relief 10 minutes after the end of inhalation, and no adverse effects were recorded. Respective initial and final median NRS scores were 80 (70-90) and 70 (60-80), p < 0.0001. Despite achieving statistical significance, the value of this point estimate is less than the 14 NRS difference that was defined a priori as representing a minimum clinically significant difference in pain severity.Conclusion: 0.2 mg/kg nebulized morphine is not effective in managing acute pain in an emergency setting. In spite of the potential advantages of the pulmonary route of administration, opioids should be intravenous prescribed at short fixed intervals to control severe acute pain in an emergency setting.

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Long-term efficacy and safety of duloxetine in the management of painful chemotherapy induced peripheral neuropathy.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.31_suppl.236 ◽

2017 ◽

Vol 35 (31_suppl) ◽

pp. 236-236

Author(s):

Sang Mi Ro ◽

In Sook Woo

Keyword(s):

Advanced Cancer ◽

Systemic Chemotherapy ◽

Rating Scale ◽

Numerical Rating Scale ◽

Vinca Alkaloid ◽

Disease Status ◽

Chemotherapeutic Agents ◽

Duration Of Treatment ◽

Average Pain ◽

Numerical Rating

236 Background: Accordingly, Quality of life in the survivorship of patients with cancer is becoming one of the important issues with a development of systemic anticancer treatment. About 40% of the patients who receive chemotherapeutic agents which have neuropathic potential suffer from painful CIPN. Various approaches to relieve the pain associated with CIPN have been attempted in clinical practice. Previously duloxetine, a dual reuptake inhibitor of serotonin and norepinephrine, has been reported to reduce painful CIPN when administered for 5 weeks. We retrospectively investigated the effect of duloxetine on the pain associated with CIPN over a prolonged period of administration. Methods: Between December 2014 and December 2016, patients with advanced cancer who complained of CIPN during or after systemic chemotherapy were eligible. Initially, 30 mg of duloxetine was administered daily for the first week and 60 mg daily was administered from the second week thereafter. The severity of pain was evaluated using a numerical rating scale from 0 to 10. Study follow-up was performed at regular visits according to the chemotherapy schedule or at the time of evaluation of disease status in the patients who completed systemic chemotherapy. However, the patients were allowed to visit whenever needed. Results: Twenty-seven patients were evaluable, the median age was 64 years (range, 23-83 years), and 11 patients were male and 16 patients were female. Twenty-four of the 27 patients received neurotoxic chemotherapeutic agents such as cisplatin, oxaliplatin, taxane and vinca alkaloid. Patients receiving duloxetine showed a significant reduction in the pain intensity from baseline and the mean decrease in the average pain score was 2.85 (95% CI 2.26-3.44, P < 0.001). Twenty-five (92.5%) of the 27 patients showed decreased pain after the use of duloxetine. Mean duration of treatment was 29 weeks (range, 1~130 weeks). Median duration of response was 19 weeks (range, 4~99 weeks). Treatment-related adverse events were nausea (17.2%), vomiting (3.4%) and dizziness (6.8%). Conclusions: Duloxetine demonstrated a durable efficacy and tolerability for painful CIPN in patients with advanced cancer.

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