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Multicenter Study
. 2011 Apr 10;29(11):1472-8.
doi: 10.1200/JCO.2010.33.0308. Epub 2011 Mar 7.

Natural history of paclitaxel-associated acute pain syndrome: prospective cohort study NCCTG N08C1

Charles L Loprinzi  1 , Brandi N Reeves, Shaker R Dakhil, Jeff A Sloan, Sherry L Wolf, Kelli N Burger, Arif Kamal, Nguyet A Le-Lindqwister, Gamini S Soori, Anthony J Jaslowski, Paul J Novotny, Daniel H Lachance
Affiliations
Multicenter Study

Natural history of paclitaxel-associated acute pain syndrome: prospective cohort study NCCTG N08C1

Charles L Loprinzi et al. J Clin Oncol. .

Abstract

Purpose: The characteristics and natural history of the paclitaxel-acute pain syndrome (P-APS) and paclitaxel's more chronic neuropathy have not been well delineated.

Methods: Patients receiving weekly paclitaxel (70 to 90 mg/m(2)) completed daily questionnaires and weekly European Organisation for Research and Treatment of Cancer (EORTC) Chemotherapy-Induced Peripheral Neuropathy (CIPN) -20 instruments during the entire course of therapy.

Results: P-APS symptoms peaked 3 days after chemotherapy. Twenty percent of patients had pain scores of 5 to 10 of 10 with the first dose of paclitaxel. Sensory neuropathy symptoms were more prominent than were motor or autonomic neuropathy symptoms. Of the sensory neuropathy symptoms, numbness and tingling were more prominent than was shooting or burning pain. Patients with higher P-APS pain scores with the first dose of paclitaxel appeared to have more chronic neuropathy.

Conclusion: These data support that the P-APS is related to nerve pathology as opposed to being arthralgias and/or myalgias. Numbness and tingling are more prominent chronic neuropathic symptoms than is shooting or burning pain.

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Conflict of interest statement

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

Figures

Fig 1.
Fig 1.
(A) Mean maximal daily pain scores and 95% CI during the first paclitaxel week from the patient-reported outcome questions related to the paclitaxel–acute pain syndrome (P-APS). (B) Worst mean maximum P-APS scores over the 12 weeks of paclitaxel, segregated by the worst mean maximum P-APS scores for the first week.
Fig 2.
Fig 2.
Rates of analgesic agents used for the treatment of the paclitaxel–acute pain syndrome over time. OTC, over the counter.
Fig 3.
Fig 3.
Sensory, motor, and autonomic subscores from the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Chemotherapy-Induced Peripheral Neuropathy–20 instrument in terms of percent of baseline over time.
Fig 4.
Fig 4.
Mean numbness, tingling, and pain scores for hands and fingers (from the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Chemotherapy-Induced Peripheral Neuropathy [CIPN] –20 instrument).
Fig 5.
Fig 5.
Total sensory neuropathy, numbness, tingling, and burning/shooting pain scores (from the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Chemotherapy-Induced Peripheral Neuropathy [CIPN] –20 instrument) segregated by lower paclitaxel–acute pain scores during the week after receiving the first dose of paclitaxel versus higher scores from the patient-reported outcome questions related to the paclitaxel–acute pain syndrome (P-APS).
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