Oxaliplatin
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Peripheral neuropathy and neuropathic pain: case report A 51-year-old woman developed peripheral neuropathy and neuropathic pain following treatment with oxaliplatin for colorectal cancer (CRC). The woman, who had CRC, was treated with right hemicolectomy and tumor resection. She started receiving adjuvant chemotherapy with FLOX regimen consisting of oxaliplatin [route and dosage not stated], fluorouracil and folinic acid. However, after second chemotherapy cycle, she developed grade 3 neuropathy [time to reaction onset not clearly stated]. The woman’s chemotherapy was discontinued. Thereafter, she developed severe cold allodynia and painful dysesthesia of the hands along with occasional pharyngolaryngeal dysesthesia when drinking cold water. Six months later, she developed severe burning and tingling pain in the lower limbs. Neurological examination revealed that she had glove and stocking-like distribution of cold and pain hypoesthesia associated with intense dynamic mechanical allodynia in both feet. Nerve conduction tests confirmed axonal sensory-predominant length-dependent polyneuropathy. She was diagnosed with oxaliplatin-induced peripheral neuropathy and neuropathic pain. She was treated with first line oral therapy consisting of pregabalin, amitriptyline, gabapentin, duloxetine and venlafaxine followed by second line therapy with oral tramadol and SC botulinum toxin injection. Thereafter, she was treated with third line oral therapy with methadone and oxycodone [dosages not stated]. All these drugs were administered at the maximal tolerated dosage. However, no significant clinical improvement was observed. Eventually, her oncological follow-up was discontinued as her CRC had resolved. However, her refractory pain persisted. Therefore, she was treated with spinal cord stimulation (SCS) which resulted in significant improvement in her pain in both lower limbs. Upon follow-up, reduction was noted in her neuropathic pain symptom inventory score, superficial-spontaneous and evoked pain and dysesthesia subscores. Thereafter, her pain medications were progressively reduced. Lopes AJM, et al. Spinal Cord Stimulation as a Treatment Option for Refractory Chemotherapy-Induced Peripheral Neuropathy: Case Report. Brazilian Neurosurgery : 2020. 803497863 Available from: URL: http://doi.org/10.1055/s-0040-1709985
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Reactions 22 Aug 2020 No. 1818
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