Matsuoka, H, Iwase, S, Miyaji, T, Kawaguchi, T, Ariyoshi, K, Oyamada, S, Satomi, E, Ishiki, H, Hasuo, H, Sakuma, H, Tokoro, A, Matsuda, Y, Tahara, K, Otani, H, Ohtake, Y, Tsukuura, H, Matsumoto, Y, Hasegawa, Y, Kataoka, Y, Otsuka, M, Sakai, K, Nakura, M, Morita, T, Yamaguchi, T & Koyama, A 2020, 'Predictors of duloxetine response in patients with neuropathic cancer pain: a secondary analysis of a randomized controlled trial—JORTC-PAL08 (DIRECT) study', Supportive Care in Cancer, vol. 28, pp. 2931-2939.View/Download from: Publisher's site
© 2019, Springer-Verlag GmbH Germany, part of Springer Nature. Purpose: Duloxetine has some effect against cancer neuropathic pain (CNP); however, predictors of duloxetine response are unclear. This study sought to identify predictors of duloxetine response in patients with CNP. Methods: Patients (N = 70) with CNP unresponsive to or intolerant of opioid–pregabalin combination therapy, with a brief pain inventory-short form (BPI-SF) Item 5 score (average pain) ≥ 4, and with a total hospital anxiety and depression scale score < 20, were randomized to a duloxetine or a placebo group. Multiple linear regression analysis was conducted to identify predictors of duloxetine response as a secondary analysis with the change in the average pain score on day 10 from day 0 as the dependent variable, and the following five covariates; baseline (day 0) average pain score, baseline opioid dose, continuation/discontinuation of pregabalin, and items 20 and 21 score of the short-form McGill pain questionnaire 2 (SF-MPQ-2) as independent variables. Results: Of the four domains (continuous pain, intermittent pain, neuropathic pain, and affective descriptors) score of SF-MPQ-2 on day 0, significant differences were observed in the neuropathic pain domain (p = 0.040) in change on the average pain between day 10 and day 0 in the duloxetine group. Multiple linear regression analysis revealed that patients with a high score for SF-MPQ-2 Item 21 (tingling pain) on day 0 had a significantly greater change in average pain between day 10 and day 0 (p = 0.046). Conclusion: Patients with a high score for SF-MPQ-2 Item 21 might benefit more from duloxetine.
Matsuoka, H, Iwase, S, Miyaji, T, Kawaguchi, T, Ariyoshi, K, Oyamada, S, Satomi, E, Ishiki, H, Hasuo, H, Sakuma, H, Tokoro, A, Shinomiya, T, Otani, H, Ohtake, Y, Tsukuura, H, Matsumoto, Y, Hasegawa, Y, Kataoka, Y, Otsuka, M, Sakai, K, Matsuda, Y, Morita, T, Koyama, A & Yamaguchi, T 2019, 'Additive Duloxetine for Cancer-Related Neuropathic Pain Nonresponsive or Intolerant to Opioid-Pregabalin Therapy: A Randomized Controlled Trial (JORTC-PAL08).', Journal of pain and symptom management, vol. 58, no. 4, pp. 645-653.View/Download from: Publisher's site
CONTEXT:Although opioids and pregabalin are widely used for cancer-related neuropathic pain (CNP), no clinical trials exist to determine which medications are effective when an opioid-pregabalin combination therapy fails. OBJECTIVES:We investigated the efficacy of duloxetine for CNP nonresponsive or intolerant to opioid-pregabalin combination therapy. METHODS:A multicenter, randomized, double-blind, placebo-controlled trial was performed at 12 specialized palliative care services in Japan. Patients with CNP average pain scores (Brief Pain Inventory [BPI]-Item 5) ≥ 4 in the previous 24 hours and nonresponsive or intolerant to opioid-pregabalin combination therapy were eligible. Patients with chemotherapy-induced peripheral neuropathies were excluded. Patients were administered duloxetine 20 mg/day titrated to 40 mg/day or placebo for 10 days. The primary endpoint was BPI-Item 5 on Day 10. Responder analysis measured proportions of patients with 30% and 50% pain decreases. RESULTS:Seventy patients were enrolled. Complete case analysis revealed mean BPI-Item 5 on Day 10 of 4.03 for Group D vs. 4.88 for Group P (P = 0.053). Baseline observation carried forward analysis revealed mean BPI-Item 5 on Day 10 of 4.06 and 4.91 for Groups D and P, respectively (P = 0.048). Clinically meaningful pain improvement (≥30%) was reported by 44.1% (n = 15) of patients in Group D vs. 18.2% (n = 6) in Group P (P = 0.02); 32.4% (n = 11) vs. 3.0% (n = 1) of patients in Groups D and P, respectively, reported pain reduction ≥ 50% (P = 0.002). CONCLUSION:Adding duloxetine to opioid-pregabalin therapy might have clinical benefit in alleviating refractory CNP. Further studies are needed to conclude the efficacy of adding duloxetine.
Matsuoka, H, Tagami, K, Ariyoshi, K, Oyamada, S, Kizawa, Y, Inoue, A & Koyama, A 2019, 'Attitude of Japanese palliative care specialists towards adjuvant analgesics cancer-related neuropathic pain refractory to opioid therapy: A nationwide cross-sectional survey', Japanese Journal of Clinical Oncology, vol. 49, no. 5, pp. 486-490.View/Download from: Publisher's site
© The Author(s) 2019. Cancer-related neuropathic pain (CNP) requires therapy involving multiple pharmaceuticals, including anticonvulsants and antidepressants; however, strong evidence to support this practice is limited. This study is a cross-sectional questionnaire-based survey. As the standard dose of adjuvant analgesics for CNP refractory to opioid therapy is not clear, the purpose of this study is to clarify the opinions of specialists about the usage of duloxetine and pregabalin for patients with CNP refractory to opioid therapy. Two hundred and eight certified palliative care specialists were surveyed and a total of 87 (42%) responses were analyzed. Twenty-five percent of specialists had considered increasing duloxetine doses up to 60 mg/day and 58% had considered increasing pregabalin doses up to 300 mg/day for CNP refractory to opioid therapy. However, 23% of the specialists succeeded in increasing duloxetine doses up to 60 mg/day and 17% in increasing pregabalin doses up to 300 mg/day, respectively.
Matsuoka, H, Agar, M, Vandersman, Z, Good, P, Fazekas, B, Brown, L, Hardy, J, Weil, J & Currow, DC 2019, 'Harms From Haloperidol for Symptom Management in Palliative Care-a Post Hoc Pooled Analysis of Three Randomized Controlled Studies and Two Consecutive Cohort Studies.', Journal of Pain and Symptom Management, vol. 58, no. 3, pp. e6-e8.View/Download from: Publisher's site
Matsuoka, H, Allingham, S, Fazekas, B, Brown, L, Vandersman, Z, Clark, K, Agar, MR & Currow, DC 2019, 'Comparability of the Australian National Cancer Symptom Trials (CST) Group's Study Populations to National Referrals to Non-CST Specialist Palliative Care Services Participating in the Palliative Care Outcomes Collaboration.', Journal of Pain and Symptom Management, vol. 57, no. 1, pp. e9-e14.View/Download from: Publisher's site