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Clinical Trial
. 2013 Jun;71(6):1531-40.
doi: 10.1007/s00280-013-2152-7. Epub 2013 Mar 31.

Subclinical pretreatment sensory deficits appear to predict the development of pain and numbness in patients with multiple myeloma undergoing chemotherapy

Elisabeth G Vichaya  1 , Xin Shelley Wang, Jessica A Boyette-Davis, Tito R Mendoza, Zijing He, Sheeba K Thomas, Nina Shah, Loretta A Williams, Charles S Cleeland, Patrick M Dougherty
Affiliations
Clinical Trial

Subclinical pretreatment sensory deficits appear to predict the development of pain and numbness in patients with multiple myeloma undergoing chemotherapy

Elisabeth G Vichaya et al. Cancer Chemother Pharmacol. 2013 Jun.

Abstract

Purpose: Chemotherapy-induced peripheral neuropathy is a major complication in the treatment for cancer, including multiple myeloma (MM). Patients may develop painful and non-painful (e.g., numbness) neuropathy symptoms that impair function and often persist after therapy is terminated. This study tested the hypothesis that baseline subclinical neuropathy, as assessed by sensory thresholds, is related to the development of neuropathy symptoms (e.g., pain and numbness) in patients with MM undergoing treatment with chemotherapy.

Methods: Patients (n = 56) who had undergone two or fewer cycles of induction therapy and who had no evident neuropathy were assessed using quantitative sensory tests to determine multiple-modality sensory thresholds. Patient-reported pain and numbness were assessed through induction therapy (16 weeks) via the MD Anderson Symptom Inventory. A subset of participants (n = 15) continued reporting on their symptoms for an additional 16 weeks ("maintenance phase").

Results: Patients with sharpness detection deficits at baseline (n = 11, 20 % of sample) reported less severe pain and numbness during induction therapy and less numbness during maintenance therapy (P < 0.05). During the maintenance phase, patients with warmth detection deficits (n = 5, 38 % of sample) reported more severe pain and numbness, and those with skin temperature deficits (n = 7, 47 % of maintenance sample) reported more severe pain (P < 0.05). These deficits were related to patient reported difficulty walking, a common symptom of peripheral neuropathy.

Conclusion: Our results suggest that baseline subclinical sensory deficits may be related to a patient's risk for developing chemotherapy-induced peripheral neuropathy.

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Figures

Figure 1
Figure 1
Patient-reported pain and numbness by QST baseline deficit category. A, Pain reported during induction therapy. B, Numbness reported during induction therapy. C, Pain reported during maintenance therapy. D, Numbness reported during maintenance therapy. *Asterisks indicate P < 0.008.
Figure 2
Figure 2
Pain reported in: A, patients with (n=11) and without (n=44) sharpness detection deficits during induction therapy ; B, patients with (n=3) and without (n=12) sharpness detection deficits during maintenance therapy; C, patients with (n=20) and without (n=30) warmth detection deficits during induction therapy ; D, patients with (n=5) and without (n=8) warmth detection deficits during maintenance therapy ; E, patients with (n=17) and without (n=38) skin temperature deficits during induction therapy ; and F, patients with (n=7) and without (n=8) skin temperature deficits during maintenance therapy.
Figure 3
Figure 3
Numbness reported in: A, patients with (n=11) and without (n=44) sharpness detection deficits during induction therapy; B, patients with (n=3) and without (n=12) sharpness detection deficits during maintenance therapy; C, patients with (n=5) and without (n=8) warmth detection deficits during maintenance therapy; D, patients with (n=5) and without (n=8) warmth detection deficits during maintenance therapy.
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