Effectiveness of gabapentin pharmacotherapy in chemotherapy-induced peripheral neuropathy

Magnowska, Magdalena; Iżycka, Natalia; Kapoła-Czyż, Joanna; Romała, Anna; Lorek, Jakub; Spaczyński, Marek; Nowak‐Markwitz, Ewa

doi:10.5603/gp.a2018.0034

Cited by 23 publications

(20 citation statements)

References 10 publications

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“…Cancer-related NP is challenging to treat because patients often experience multiple sources of pain from disease and/or treatment, leading to high opioid exposure in this population [11]. While lines of therapy for cancer related NP in adults follow the general strategies used for non-cancer related NP, starting with TCAs, SNRIs, and gabapentinoids as first line therapies, the dose regimens seem to have not been escalated to the maximum doses reported in the general NP literature [4,5,[7][8][9][10].…”

Section: Treatment Concepts For Np In Adultsmentioning

confidence: 99%

“…Successful treatment of NP conditions is challenging and may require multiple lines of therapy; pain may be difficult to adequately control leading to the concept of "pharmaco-resistant NP" [2]. While NP is well characterized in adults with cancer [3][4][5][6][7][8][9][10][11][12][13][14][15], it is less well described in pediatric oncology [16][17][18][19][20][21][22]. In the setting of pain in pediatric oncology patients, NP can be caused by a variety of types of somatosensory system injuries including chemotherapyrelated NP [19,23], tumor-related NP [24][25][26], post-surgical NP [27,28], and the complex circumstances of NP at the end-of-life [29].…”

Section: Introductionmentioning

confidence: 99%

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Neuropathic Pain in Pediatric Oncology: A Clinical Decision Algorithm

Anghelescu

Tesney

2019

Pediatr Drugs

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Neuropathic pain in pediatric oncology results from distinct causes of lesions or disease processes affecting the somatosensory system including chemotherapy-related neuronal injury, solid tumor related involvement of neural structures, post-surgical neuropathic pain including phantom limb pain and post-limb sparing pain, and the complex circumstances of neuropathic pain at the end of life. While treatment algorithms reflect the general treatment principles applied for adult neuropathic pain, the dose regimens applied in children are modest and rarely escalated to the maximum doses to optimize analgesic efficacy. Pharmacological management of neuropathic pain should be based on a stepwise intervention strategy, as the most effective approach is with combinations of medications. Gabapentinoids and tricyclic antidepressants are recommended as first line therapy agents. Methadone, ketamine, and lidocaine may be useful adjuvants in selected patients.Prospective studies extended over a substantial length of time are recommended based on the nature of neuropathic pain as persistent, chronic pain and based on the need for sufficient time to escalate medication dose regimens to full analgesic efficacy.

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Section: Treatment Concepts For Np In Adultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Neuropathic Pain in Pediatric Oncology: A Clinical Decision Algorithm

Anghelescu

Tesney

2019

Pediatr Drugs

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“…Systemic treatment with gabapentin in clinical doses adjusted for neuropathic pain has been associated with somnolence, dizziness, ataxia, and fatigue [28]. This can be further endorsed by the withdrawal rate of patients due to such adverse effects in clinical studies on systemic gabapentin efficacy in CIPN [23]. In this study, using different testing paradigms, systemic gabapentin produced only a transient increase in locomotion but induced considerable impairment of motor coordination.…”

Section: Discussionmentioning

confidence: 84%

“…Preclinical studies have demonstrated that gabapentin is able to attenuate both the positive and negative neuropathic symptoms of CIPN [15, 21]. However, there is conflicting evidence of gabapentin efficacy in clinical trials, with some studies showing a meaningful reduction in pain scores in patients [22, 23], while others have obtained negative results [24, 25]. Irrespective of these observations, gabapentin has been considered a common choice of clinicians to manage the positive symptoms associated with CIPN [26, 27].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of a topical gabapentin gel in a cisplatin paradigm of chemotherapy-induced peripheral neuropathy

Shahid

Subhan

Ahmad

et al. 2019

BMC Pharmacol Toxicol

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Background Chemotherapy induced peripheral neuropathy (CIPN) has been attributed to chemotherapeutic agents such as cisplatin which adversely affect disease outcome leading to increased cancer related morbidity. The clinical efficacy of systemic gabapentin in neuropathic pain management is limited by central side-effects in addition to a scarceness of conclusive evidence of its efficacy in CIPN management. The topical route therefore may provide a relatively safe alternative for neuropathic pain treatment in general and CIPN in particular. Methods Cisplatin induced neuropathic nociception was established in rats after a single weekly cisplatin injection (3.0 mg/kg, intraperitoneally) for 4 weeks. The evoked neuropathic sensation of allodynia was assessed by plantar application of von Frey monofilaments as the paw withdrawal threshold (PWT), whereas the expression of heat-hypoalgesia was determined on a hot-plate as paw withdrawal latency (PWL). Gabapentin gel (10% w/w) was applied three-times daily on the hind paws while in a concurrent systemic study, gabapentin was administered daily (75 mg/kg, intraperitoneally) for 4 weeks. To assess any evidence of neurological adverse symptoms of cisplatin and the central side-effect propensity of systemic or topical gabapentin, evaluation of motor coordination (rotarod test) and gait (footprint analysis) were performed. Results Cisplatin invoked a progressive development of neuropathic hind paw allodynia (decreased PWT, days 7–28) and heat hypoalgesia (increased PWL, days 21–28). Topical gabapentin significantly delayed the expression of both allodynia on protocol days 21 and 28 and heat-hypoalgesia (day 28). Systemic gabapentin displayed a comparative anti-neuropathic predisposition through a sustained suppression of tactile allodynia on days 14 and 21–28 as well as thermal hypoalgesia (days 21 and 28). Systemic gabapentin also impaired motor coordination and gait thus affirming its clinically documented central side effects, but these outcomes were not evident after topical treatment. Conclusions Both topical and systemic gabapentin exhibit a propensity to attenuate CIPN in a cisplatin paradigm. Gabapentin applied topically may therefore provide an adjunctive or alternative route for CIPN management upon cessation of systemic medications due to intolerable side-effects. Electronic supplementary material The online version of this article (10.1186/s40360-019-0329-3) contains supplementary material, which is available to authorized users.

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“…Antidepressants (such as nortriptyline), duloxetine, gabapentin, and a compounded topical gel containing baclofen, amitriptyline, ketamine, lidocaine, tramadol, tapentadol, buprenorphine, and lithium have been tested. 32 - 41 These agents had a record of efficacy for other common neuropathic pain conditions, but CIPN has a different pathologic origin. The America Society of Clinical Oncology does not recommend any agent for the prevention of CIPN.…”

Section: Introductionmentioning

confidence: 99%

Innovative Approach for the Prevention of Chemotherapy-Induced Peripheral Neuropathy in Cancer Patients: A Pilot Study With the Hilotherm Device, the Poliambulanza Hospital Experience

et al. 2020

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Background: Chemotherapy-induced peripheral neuropathy (CIPN) is an adverse event of taxanes, with no effective prevention or treatment available and a highly negative impact on patient quality of life. The aim of this study is to asses that the constant application of cooled cuffs on the hands and feet prevent and mitigate CIPN. Methods: Patients with breast, gynecologic, and pancreatic cancer who received weekly paclitaxel (PTX), PTX/carboplatin, and nab-paclitaxel (nab-PTX)/gemcitabine for any indication at the therapeutic scheduled dosage were included in this prospective study. Hilotherm Chemo care device forms a closed-loop system with cuffs and tubes through which a coolant flows at a temperature of 10 °C. CIPN was monitored using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (edition 3.0), and the tolerability and side effects were scored by using the Common Terminology Criteria for Adverse Events (T4.03 2017). Results: To date, we have enrolled 64 patients. Of these, 54 (84%) completed all cooling cycles. Continuous cooling was well tolerated by all patients. No patients had grade >2 CIPN or had serious or lasting adverse events as a result of Hilotherapy. The median time to CIPN onset was 77 days for the entire population. Conclusion: Hilotherapy has good effectiveness and tolerability and seems to be able to prevent or reduce the symptoms of CIPN. We are still recruiting patients to obtain more data and to collect data at 3 months after the end of chemotherapy. Prospective studies seem to be warranted.

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Effectiveness of gabapentin pharmacotherapy in chemotherapy-induced peripheral neuropathy

Abstract: Chemotherapy substantially deteriorates the neurologic condition of the patients and the quality of life. Paclitaxel and carboplatin treated patients may benefit from gabapentin therapy in chemotherapy-induced peripheral neuropathy.

Cited by 23 publications

References 10 publications

Neuropathic Pain in Pediatric Oncology: A Clinical Decision Algorithm

Neuropathic Pain in Pediatric Oncology: A Clinical Decision Algorithm

Efficacy of a topical gabapentin gel in a cisplatin paradigm of chemotherapy-induced peripheral neuropathy

Innovative Approach for the Prevention of Chemotherapy-Induced Peripheral Neuropathy in Cancer Patients: A Pilot Study With the Hilotherm Device, the Poliambulanza Hospital Experience

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