Mechanisms, Predictors, and Challenges in Assessing and Managing Painful Chemotherapy-Induced Peripheral Neuropathy.
Grace A Kanzawa-Lee, Robert Knoerl, Clare Donohoe and 2 others
PMID 31053396WHAT IT FOUND
Duloxetine is the only recommended drug for established painful chemotherapy-induced peripheral neuropathy.
No cure exists, and complementary therapies such as exercise, acupuncture, and scrambler therapy lack adequate evidence for CIPN pain.
Key findings
01No curative treatment for chemotherapy-induced peripheral neuropathy has been found, and duloxetine is the only drug recommended for established painful CIPN caused by oxaliplatin or paclitaxel.
02In a randomized placebo-controlled trial of 231 patients, duloxetine 60 mg daily produced a larger mean decrease in average pain score than placebo (P = .003).
03Acupuncture results were mixed, scrambler therapy had only preliminary quasi-experimental evidence, and exercise studies did not adequately test painful CIPN as the primary outcome; none of these complementary treatments can be recommended for CIPN pain.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This is a narrative review, not a new trial or systematic review, so it does not report methods for selecting studies or quality appraisal. The treatment conclusions rest on a small number of studies that specifically measured pain; many earlier trials used non-pain outcomes or poor pain measurement. Predictor findings are uncertain because the cited studies used different pain and CIPN measures and definitions. The Web-based CBT result is from a small pilot with no blinding and 22% attrition, so it is preliminary. Preclinical animal studies of preventive agents are not evidence that a treatment works in patients.
Declared interests
Robert Knoerl reports a consulting honorarium from System Analytic. The other authors have no conflicts to disclose. The article is tagged as supported by NIH and non-U.S. government research funding.
The easy way to misread this
Do not conclude that duloxetine will work for every patient with chemotherapy-induced neuropathy or that it prevents the condition. It is recommended only for established painful CIPN caused by oxaliplatin or paclitaxel, no curative treatment has been found, and no human trial has shown prevention.