|
Sign In to gain access to subscriptions and/or personal tools.
|
Palliative Medicine, Vol. 21, No. 8,
667-672 (2007)
DOI: 10.1177/0269216307083031
Flecainide for the treatment of chronic neuropathic pain: a Phase II trial
Charles F. von Gunten
Northwestern University, Chicago, Illinois, cvongunten{at}sdhospice.org
Sarah Eappen
Dana-Farber Cancer Institute, Boston, Massachusetts
James Francis Cleary
University of Wisconsin, Madison, Wisconsin
Samuel G. Taylor, IV
Illinois Masonic Medical Center, Chicago, Illinois
Paul Moots
Vanderbilt University, Nashville, Tennessee
Nina Regevik
Raritan Bay Medical Center, Perth Amboy, New Jersey
Charles Cleeland
Anderson Cancer Center, Houston, Texas
David Cella
Evanston Northwestern Healthcare, Evanston, Illinois
Background: Management of neuropathic pain is challenging. Medications that interfere with sodium channel transport, such as lidocaine, mexilitene and flecainide, are promising as analgesics. Objective: In a general population of patients with a working diagnosis of neuropathic pain, whether if flecainide produces enough of an improvement in pain to warrant further clinical study is determined. Design: Phase I/II prospective exploratory clinical trial. Eligible patients were observed for week 1, then 50 mg flecainide was administered twice daily for week 2 and then administered 100 mg twice daily for week 3. Setting/ Subjects: Multi-institutional members of the Eastern Co-operative Oncology Group. Patients had neuropathic pain diagnosed by their oncologists as defined by the International Association for the Study of Pain and a diagnosis of cancer or AIDS. Measurements: The Wisconsin Brief Pain Inventory was used. The primary endpoint was a decrease of 3 points (0—10 numerical scale) or a decrease of 50% in the worst pain rating at either day 15 or day 22 relative to the average of days 1 and 8 ratings. Results: Nineteen patients were registered for the study. Four patients were ineligible. Of the remaining 15, one was unevaluable due to incomplete pain rating. Four out of 14 patients had an average drop of 5 points or 53% in their worst pain ratings on a 0—10 numerical scale of pain. No patients withdrew from study because of toxicity. There were no life-threatening or lethal toxicities. All patients were alive at the time of the analysis. Conclusions: Flecainide produced a 30% response rate. Response in this study was defined to be highly relevant and clinically significant reduction in pain. The drug merits study in a randomized placebo-controlled trial. Palliative Medicine 2007; 21: 667—672
Key Words: neuropathic • pain • cancer • flecainide • AIDS
References
- McDonald AA, Portenoy RK How to use antidepressants and anticonvulsants as adjuvant analgesics in the treatment of neuropathic cancer pain. J Support Oncol 2006; 4: 43052.
- Ferris FD, von Gunten CF, Emanuel LL Ensuring competency in end-of-life care: controlling symptoms. BMC Palliat Care 2002; 1: 5.[CrossRef][Medline]
[Order article via Infotrieve]
- Stjernsward J., Teoh N. The cancer pain relief program of the World Health Organization. Palliat Med 1989; 4: 1—3.[Medline]
[Order article via Infotrieve]
- Ventafridda V., Stjernsward J. Pain control and the World Health Organziation analgesic ladder. JAMA 1996; 275: 835—6.[CrossRef][ISI][Medline]
[Order article via Infotrieve]
- Fallon M., McConnell S. The principles of cancer pain management. Clin Med 2006; 2: 136—9.
- IASP Subcommittee on Taxonomy Classification of Chronic Pain. Pain 1986; 3(Suppl): S1—225.
- Gilron I., Watson CP, Cahill CM, Moulin DE Neuropathic pain: a practical guide for the clinician. CMAJ 2006; 175(3): 265—75.[Abstract/Free Full Text]
- Iwane T., Maruyama M., Matsuki M., Ito Y., Shimoji K. Management of intractable pain in adiposis dolorosa with intravenous administration of lidocaine. Anesth Analg 1976; 55(2): 257—9.[Abstract/Free Full Text]
- Challapalli V., Tremont-Lukats IW, McNicol ED, Lau J., Carr DB Systemic administration of local anesthetic agents to relieve neuropathic pain. Cochrane Database Syst Rev 2005; 4: CD003345.
- Thomas J., Kronenberg R., Cox MC, Naco GC, Wallace M., von Gunten CF. Intravenous lidocaine relieves severe pain: results of an inpatient hospice chart review. J Palliat Med 2004; 7(5): 660—7.[CrossRef][Medline]
[Order article via Infotrieve]
- Ferrini R. Parenteral lidocaine for severe intractable pain in six hospice patients continued at home. J Palliat Med 2000; 3(2): 193—200.[CrossRef][Medline]
[Order article via Infotrieve]
- Ferrini R., Paice JA How to initiate and monitor infusional lidocaine for severe and/or neuropathic pain. J Support Oncol 2004; 2(1): 90—4.[Medline]
[Order article via Infotrieve]
- Working Group on Arrhythmias. The Sicilian Gambit: a new approach to the classification of antiarrhythmic drugs based on their actions on arrhythmogenic mechanisms. Circulation 1991; 84: 1831—51.[Abstract/Free Full Text]
- Sloan P., Basta M., Storey P., von Gunten C. Mexiletine as an adjuvant analgesic for the management of neuropathic cancer pain. Anesth Analg 1999; 89: 760—1.[Free Full Text]
- Dejgard A., Petersen P., Kastrup J. Mexiletine for treatment of chronic painful diabetic neuropathy. Lancet 1988; 2(9): 9—11.[ISI]
- Dunlop R., Davis RJ, Hockley J., Turner P. Analgesic effects of oral flecainide. Lancet 1988; 1(8582): 420—1.[ISI][Medline]
[Order article via Infotrieve]
- Mendoza T., Mayne T., Rublee D., Cleeland C. Reliability and validity of a modified Brief Pain Inventory short form in patients with osteoarthritis. Eur J Pain 2006; 10: 353—61.[CrossRef][ISI][Medline]
[Order article via Infotrieve]
- National Cancer Institute Common Toxicity Criteria. http://ctep.cancer.gov/forms/CTCv20_4-30-992.pdf (Accessed 24 July 2006).
- Hrobjartsson A., Gotzxche PC Is the placebo powerless? An analysis of clinical trials comparing placebo with no treatment. N Engl J Med 2001; 344: 1594—602.[Abstract/Free Full Text]
- Echt DS, Liebson PR, Mitchell LB et al. Mortality and morbidity in patients receiving encainide, flecainide, or placebo: the cardiac arrhythmia suppression. Trial N Engl J Med 1991; 324: 781—8.[Abstract]
- Marriott Hjl, Conover MB Advanced concepts in arrhythmias, second edition, CV Mosby, 1989: 174.
- Working Group on Arrhythmias. The Sicilian Gambit: a new approach to the classification of antiarrhythmic drugs based on their actions on arrhythmogenic mechanisms. Circulation 1991; 84: 1831—51.[Abstract/Free Full Text]
- Brosen K. Recent developments in hepatic drug oxidation: implications for clinical pharmacokinetics. Clin Pharmacokinet 1990; 18: 220—39.[ISI][Medline]
[Order article via Infotrieve]
- Brosen K., Gram LF Clinical significance of the sparteine/ debrisoquine oxidation polymorphism. Eur J Clinical Pharmacol 1989; 36: 537—47.
- Wallace MS, Dyck JB, Rossi SS, Yaksh TL Computer-controlled lidocaine infusion for the evaluation of neuropathic pain after peripheral nerve injury. Pain 1996; 66(1): 69—77.[CrossRef][ISI][Medline]
[Order article via Infotrieve]
- Wallace MS, Laitin S., Licht D., Yaksh TL Concentration-effect relations for intravenous lidocaine infusions in human volunteers: effects on acute sensory thresholds and capsaicin-evoked hyperpathia. Anesthesiology 1997; 86(6): 1262—72.[ISI][Medline]
[Order article via Infotrieve]
- Wallace MS, Lee J., Sorkin L., Dunn JS, Yaksh T., Yu A. Intravenous lidocaine: effects on controlling pain after anti-GD2 antibody therapy in children with neuroblastoma-a report of a series. Anesth Analg 1997; 85(4): 794—6.[ISI][Medline]
[Order article via Infotrieve]
- Wallace MS, Ridgeway BM, Leung AY, Gerayli A., Yaksh TL Concentration—effect relationship of intravenous lidocaine on the allodynia of complex regional pain syndrome types I and II. Anesthesiology 2000: 92(1): 75—83.[CrossRef][ISI][Medline]
[Order article via Infotrieve]
- MacMahon S., Collins R., Peto R., Koster RW, Yusuf S. "Effects of prophylactic lidocaine in suspected acute myocardial infarction. An overview of results from the randomized, controlled trials." JAMA 1988; 260(13): 1910—6.[Abstract]
- Brookoff D. Chronic pain: a new disease? Hosp Pract 2000; 35: 45—52, 59.[Medline]
[Order article via Infotrieve]
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati What's this?
|
