A double-blind controlled trial of salmon calcitonin in pain due to malignancy

Abstract

Thirty-two patients with established malignancy and associated pain participated in a randomised double-blind controlled trial. They received salmon calcitonin SC 200 UI or matching placebo 6-hourly for 48 h and were assessed by using a combination of a 20-point visual analogue scale (VAS), a 4-point physician's global pain scale, and ranking of the co-administered analgesics into 20 grades of potency. Twenty-five patients (13 calcitonin, 12 placebo) were evaluated. Seven patients (4 calcitonin, 3 placebo) were excluded either because the initial pain score was less than or equal to 5 on the VAS, or because there were insufficient data (due to death occurring within the first week of the study or, in one patient, blindness preventing completion of the VAS). One week after commencing therapy there was improvement or marked improvement of pain in significantly more patients in the calcitonin group (5/13) than in the placebo group (0/12) (Fisher's exact two-tailed probability test, P = 0.0484). At the end of the second week three patients in the calcitonin group were still showing marked improvement.

Adjuvant Analgesics in Cancer Pain Management

“…Calcitonin may have several pain-related indications in the palliative care setting, including pain from bone metastasis [105][106][107]. The most frequent routes of administration are subcutaneous and intranasal.…”

Analgesic activity of high-dose intravenous calcitonin in cancer patients with bone metastases

“…Its analgesic activity has been demonstrated in humans (7)(8)(9)(10)(11)(12)(13) and animals (14-17), but its mechanism of analgesic action remains unclear. Several hypotheses have been formulated to account for it.…”

“…The systematic review by Martinez et al (3) concluded that the available evidence was limited, did not support the use of calcitonin to control pain from bone metastases and called for new studies to provide additional information. It should be emphasized that this review did not include the randomised double-blind placebo-controlled clinical trial by Hindley et al (11) because a 4-week cut-off was a prerequisite for inclusion in the review, while the latter study was of two-week duration. At the end of the second week, there was an improvement of pain in significantly more patients in the calcitonin group (5/13, 38%) than in the placebo group (0/12) (Fisher's exact two-tailed probability test, P<0.05).…”

“…The discontinuation of the study medication after only two weeks of unsuccessful treatment can be considered a limitation, especially when, in most studies, calcitonin is used for at least 1-3 months (7,8). Of note, we used a much higher dose than the one used in those studies (300-IU versus 100-IU) and other investigators have used durations of treatment (2 weeks) similar to that in our study in order to evaluate the efficacy of calcitonin (11). Without ignoring the cost-containment era in which we practice medicine, we believe it remains to be seen whether a regimen that is suitable for home care and consists of per os steroids, antihistamines and daily high-dose calcitonin (administered intranasally or subcutaneously) can achieve better analgesic results.…”

Inhibitory effects of salmon calcitonin on the tail-biting and scratching behavior induced by substance P and three excitatory amino acids

“…Salmon CT (SCT) has been shown to have analgesic activity against the pain of malignancy (Hindley et al, 1982), and migraine (Patti et al, 1986), and against phantom limb pain (Jaeger and Maier, 1992). The analgesic action of SCT against cancer pain did not simply augment with increase of doses: 100IU/day was more effective than 200IU/day in these patients (Berressem etal., 1985).…”