Help for Joint Pain from AIs

Hester Hill Schnipper, LICSW, OSW-C Program Manager, Oncology Social Work

MARCH 09, 2018

  Aromatase inhibitors are a major part of treatment for many women with breast cancer. Generally used for post-menopausal women with ER positive breast cancers, they are highly effective and often prevent recurrence of cancer. Younger, pre-menopausal women generally are treated with tamoxifen in the same clinical circumstances. Sometimes, younger women receive one of the AIs (there are three) along with a medicine to shut down ovarian function. Whatever the particular treatment, these hormonal or anti-estrogen therapies deliver approximately the same benefit as does chemotherapy. An example: If, immediately after surgery, a woman has a 30% chance of recurrence if she receives no further treatment, chemotherapy can cut that risk by 50%--improving her odds to a 15% chance of recurrence. If, after chemo, she also takes one of these anti-estrogen treatments, she can reduce the risk by another 50%--that is, reducing if from 15% risk to 7 or 8 % risk. Clearly we would all be happier if there were a way to reduce the risk to 0%, but we will take any help we can get.

  The major side effects of the AIs include joint pain that can range from annoying stiffness to real pain. Some women are so troubled by these aches and pains that they stop taking the pills. There are other reasons for non-compliance with this recommended therapy, but that is a big one. For me, the experience is aggravating stiffness when I first get out of bed in the morning or step out of the car after a long drive or, sometimes, even just stand up.  A few days ago, a patient asked me why my legs were so stiff when I stood up after our hour's discussion; it can be embarrassing. Again, personally, the stiffness is reduced by regular exercise. If a few days pass without my getting to the gym, it's worse. I do realize these are pretty minor complaints, and that some women truly experience pain that interferes with their quality of life.

  This is an introduction to an article from Medpage Today that describes a recent study suggesting that Duloxetine can cut this joint pain. For some women, this could literally turn out to be a life saver if it enables them to stick with the treatment.

  Here is the start and a link to read more. If you are having this difficulty, talk to your doctor. Help may be at hand.

Duloxetine Cuts Joint Pain From Preventive Breast Cancer Tx

by Kate Kneisel, Contributing Writer, MedPage Today

Duloxetine helped relieve joint pain related to aromatase inhibitor treatment in postmenopausal women with early-stage breast cancer, although the drug also was associated with more frequent low-grade toxicities, researchers reported.

The large randomized trial conducted by a nationwide U.S. oncology cooperative group showed that after 6 weeks, 68% of women taking duloxetine (n=127) reported a clinically meaningful improvement in joint pain (≥2 points decrease from baseline) compared with 49% of those randomized to receive placebo (n=128) (P=0.003), N. Lynn Henry, MD, PhD, University of Utah, and colleagues reported online in the Journal of Clinical Oncology.

Average joint pain score at the 12-week primary endpoint, adjusted for stratification factors (baseline pain score of 4-6 or 7-10 and prior taxane use) was 0.82 points lower for patients who received duloxetine compared with those who received placebo (95% CI, 21.24 to 20.40; P = .0002), with similar patterns observed for worst joint pain, joint stiffness, pain interference with daily activities, and functioning. Results were similar if all follow-up scores within 14 weeks were included (20.76; 95% CI, 21.17 to 20.34; P=0.0004).

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