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Effect of duloxetine on pain, function, and quality of life among patients with chemotherapy-induced painful peripheral neuropathy: a randomized clinical trial
This randomised, double-blind, placebo-controlled multicentre crossover trial of 231 patients evaluated the effect of duloxetine in painful chemotherapy-induced peripheral neuropathy. The peripheral neuropathy was grade 1 or higher sensory neuropathy caused by taxane (mostly paclitaxel) or oxaliplatin causing pain of at least 4/10 from the Brief Pain Inventory-Short Form "average pain" item for at least three months. Patients were randomised (1:1 allocation ratio) to either duloxetine followed by placebo or placebo followed by duloxetine (30 mg per day for a week, then 60 mg daily for 4 weeks). In the patients receiving duloxetine first, they reported a mean decrease in average pain of 1.06 on an 11 point numeric rating scale (0.34 in the placebo group). Nearly 60% of patients initially receiving duloxetine had some reduction of pain (38% in the placebo group). A 30% and 50% pain reduction was 2 and 2.4 times more common with duloxetine than with placebo. Duloxetine also improved pain interfering with daily functioning, quality of life, numbness and tingling in the feet, and use of analgesics. Duloxetine was more effective in people treated with platinums than with taxanes. More people in the duloxetine first group dropped out because of side effects (11% v 1%), most commonly fatigue, insomnia and nausea, although none were serious.
Studies to reduce unnecessary medication use in frail older adults: a systematic review
In a systematic review of interventions that reduced medication use in frail older adults and those who were at the end of life, 15 randomised controlled trials, four non-randomised trials, six pre–post studies and 11 case series were …
Competing interests None.
Provenance and peer review Commissioned; internally peer reviewed.