Antidepressant May Ease Cancer Pain

Cymbalta reduced chemotherapy induced painful neuropathy

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Chemotherapy can and does save lives. These powerful cancer medicines also have side effects that can last years. But an existing medication may come to the rescue.

A recent study showed that the antidepressant Cymbalta (duloxetine) helped ease the pain of nerve damage caused by chemotherapy.

The medication worked best in patients who had received platinum-based chemotherapies, such as oxaliplatin.

"Know what type of chemotherapy you're receiving."

According to the study authors, about one in three people undergoing chemotherapy develops a nerve condition called neuropathy that can cause pain, numbness, tingling, swelling or muscle weakness.

Neuropathy – also called peripheral neuropathy – often starts in the hands and/or feet but can affect other areas of the body as well.

The condition can last for months or years after chemotherapy ends. As such, the condition affects the overall quality of a person’s life.

Ellen M. Lavoie Smith, PhD, of the University of Michigan School of Nursing in Ann Arbor, led a randomized phase lll trial to evaluate the impact of duloxetine on chemotherapy-induced peripheral neuropathic pain.

Previous studies have shown the medication to be helpful in treating neuropathy in patients with diabetes.

“Treatment of painful chemotherapy-induced peripheral neuropathy continues to be a challenge because most drugs tested to date have fallen short of providing adequate pain relief,” the authors wrote.

For the study, 231 patients being treated with chemotherapy between 2008 and 2011 received either duloxetine followed by a placebo (fake medication) or a placebo followed by duloxetine.

The patients were grouped according to the type of chemotherapy agents they received and other conditions they had at the time that could have affected their pain levels.

The chemotherapy groups included patients who had received platinum-based chemotherapies – primarily oxaliplatin (brand name Eloxatin) – or a taxane chemotherapy.

Each of the study members had a pain level of at least 4 on a scale of 0 to 10, with zero representing no pain. During the five-week treatment regimen, participants were given one 30 mg capsule of duloxetine or placebo for the first week and two capsules of either 30 mg of duloxetine or placebo daily for four weeks.  

The folks in the group who took the antidepressant first reported the best results, with 59 percent saying they had less pain compared to 38 percent of patients treated first with a placebo.

Not everyone benefited from the medication; 30 percent of patients who received duloxetine first saw no change in pain and 10 percent experienced more pain.

Researchers suggested that duloxetine was more beneficial for patients receiving platinum-based chemotherapies than those who got taxanes.

Of the patients treated with duloxetine first, 59 percent reported a decrease in pain versus 38 percent of patients treated with placebo first. Thirty percent of duloxetine-treated patients reported no change in pain and 10 percent reported increased pain.

Just over 40 percent of patients who first received duloxetine reported a decrease in numbness and tingling compared to 23 percent of those who received the placebo first.

The authors noted that the results suggested that patients who received platinum agents may have experienced more benefit from duloxetine than those who received taxanes.

Findings from this study were published April 2 in JAMA.

The research was funded by the National Cancer Institute Division of Cancer Prevention, the Alliance Statistics and Data Center and the Alliance Chairman.

Several of the authors disclosed financial relationships with CALBG/Alliance. One author reported a pending institutional grant from Genentech. No other conflicts of interest were disclosed.

Reviewed by: 
Review Date: 
April 2, 2013
Last Updated:
August 15, 2013