Abstract : Background: Paclitaxel therapy often result in a unique sub-acute pain syndrome, commonly termed a
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Abstract : Background: Paclitaxel therapy often result in a unique sub-acute pain syndrome, commonly termed as ‘myalgia’ or ‘arthralgia’. The pathophysiology of this syndrome is unknown and has not been demonstrated to be associated with any structural alteration of muscles or joints. We hypothesized that this syndrome was caused by a neuropathic nerve injury from paclitaxel. Herein, we characterize the clinical characteristics of this syndrome using detailed patient interviews and consider the putative mechanism(s) for these symptoms. Methods: Oncology patients who were treated with paclitaxel and developed a sub-acute pain syndrome were questioned using a detailed structured interview. Data were tabulated descriptively. Results: Eighteen patients were interviewed. The symptoms (i.e., pain) typically began 1-2 days after the infusion and lasted for a median of 4-5 days. Pain was most commonly located in the back, hips, shoulders, thighs, legs and feet, with the most common descriptors used being “aching” or “deep pain”. Commonly used adjectives to describe the pain were: radiating, shooting, aching, stabbing, and pulsating. Some patients described increased pain with weight bearing, walking, or tactile contact. When directly asked whether the pains appeared to specifically be localized to either joints or muscles, 15 of 18 patients denied so. Conclusions: Based on the nature and temporal occurrence of the paclitaxel acute pain syndrome (PAPS) symptoms, we infer that PAPS occurs as a result of sensitization of nociceptors, their fibers or the spinothalamic system. This may also explain the subsequent development in some patients of a symmetric length-dependent sensorimotor polyneuropathy. The mechanism of this syndrome needs further study. - Slides
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