Monday, April 25, 2011

Hope for alleviating aromatase inhibitor pain

Grandpa Steve reading to Daniel. Steve returns later today and Daniel and his family will be here this weekend
One 'positive' about having triple negative BC versus the estrogen fed kind is not needing to block the estrogen. ( A huge negative would be the two-threefold increase in mortality for the same size tumor). Premenopausal patients are advised to  take Tamoxifen which blocks the estrogen in breast tissue though it stimulates the estrogen in the uterine lining to no good effect. Post-menopausal patients are given aromatase inhibitors (AIs) which effectively block estrogen produced peripherally. AIs are presumably more effective in reducing recurrences but many patients experience severe joint and bone pain similar to the pain of arthritis. Also troubling is that the most likely site for metastases is the bone causing bone pain also. It is not clear to me the mechanism of this pain. Is it neuropathic pain? (due to nerve damage). It (the pain)not seem to be alleviated by anti-inflams. Why do AIs cause this and could one be developed that does not cause the pain. Presumably 20% of patients (I am surprised it is not more) decide the pain is not worth reducing their risk and stop taking the drugs.

Recently in the UM cancer research  magazine Thrive, my onc was the lead author on a study to use duloxetine (usually prescribed for depression or anxiety) to reduce this pain. This drug has been effective in treating neuropathic pain. Anyway, 75% of the patients on it  reported at least 30% reduction in pain. This study is preliminary. It has not been tested versus placebo though a study is planned. I am not sure if there has been a study using traditional drugs that treat neuropathic pain such as gabapentin. If not, they should test it.

Our Easter BBQ was fun. Ms. Maya is getting closer to walking. She can get herself to a standing position without pulling herself up on something and she can take a few steps to steady herself before falling. She can stand independently for more than 30 seconds now. She loved chewing on corn cobs yesterday. Naomi came over earlier to make a dessert. She needs to spend more time in the kitchen.


nancyspoint said...

This is a timely post for me as one fairly new to the aromatase inhibitor drug regime. So far, my pain isn't too bad, but I've been told it can be cumulative so, who knows... Have you ever heard of anyone having muscle pain?

The little one is a cutey!

lilly said...

This type of information about the disease of cancer, its treatments and methods is necessary. I've seen online information that indicates that prescription medications - Oxycodone or vicodin - are suggested by the doctors to control the pain of the disease. Although mentioned Findrxonline these medicines have dangerous side effects and abusing them can cause severe damage to patients.

Chez said...

Sue this is 'perfect' for me at this time as AIs are the only treatment option for me.
I have just been put back onto Arimidex and the joint pain has immediately become more obvious.
Although I am reluctant to take yet another 'pill' I think it is worth mentioning to my doctor. My thanks for this information.


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