Mexiletine as an Adjuvant Analgesic for the Management of Neuropathic Cancer Pain

Sloan, Paul A.; Basta, Mafdy; Storey, Porter; Gunten, Charles von

doi:10.1097/00000539-199909000-00044

Cited by 15 publications

(3 citation statements)

References 6 publications

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“…Mexiletine, a sodium channel blocker at peripheral and central sites, is effective against neuropathic pain, 7 found in cancer and in painful diabetic neuropathy. 8,9 Neither regional block nor mexiletine at the dose used affected the frequency of chronic pain in our series. The incidence of chronic pain in the controls appears to be lower than the control group of a previous study, for which we have no explanation.…”

Section: Discussionmentioning

confidence: 53%

Regional block and mexiletine: The effect on pain after cancer breast surgery

Fassoulaki

Sarantopoulos

Melemeni

et al. 2001

Regional Anesthesia and Pain Medicine

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Section: Discussionmentioning

confidence: 53%

Regional block and mexiletine: The effect on pain after cancer breast surgery

Fassoulaki

Sarantopoulos

Melemeni

et al. 2001

Regional Anesthesia and Pain Medicine

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“…An oral local anesthetic may be considered if antidepressant or anticonvulsant drugs do not achieve sufficient analgesia 69 . Intravenous or subcutaneous lidocaine may be useful in the treatment of severe, rapidly increasing neuropathic pain.…”

Section: Pain Managementmentioning

confidence: 99%

Management Strategies for Pain in Breast Carcinoma Patients: Current Opinions and Future Perspectives

Saxena

Kumar

2007

Pain Practice

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Breast cancer is the most frequently encountered carcinoma in women worldwide. Pain is the most distressing symptom in patients with breast carcinoma and can occur at all stages of the disease due to the cancer per se as well as due to various diagnostic and treatment modalities. A proper pain assessment helps in identification of pain syndromes and guides in formulating analgesic strategies. Primary therapies of breast carcinoma like surgery, chemotherapy, and radiotherapy for bony metastases can cause substantial pain relief. However, multimodal analgesic approaches incorporating pharmacological, interventional as well as non-conventional techniques should be employed prior to, in conjunction with, and after primary therapies of breast cancer. The prevalence of chronic neuropathic pain following breast cancer surgery may exceed 50% by current estimates, and with the increase in life expectancy of these patients, providing adequate pain relief is of paramount importance to improve their quality of life. In this review, we discuss prevailing methods of evaluation and management of pain in patients of breast carcinoma and the new techniques that may become the mainstay of pain management protocols in future.

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“…8,9 Neither regional block nor mexiletine at the dose used affected the frequency of chronic pain in our series. Side effects may be greater with a larger dose.…”

Section: Discussionmentioning

confidence: 53%

Regional Block and Mexiletine

Fassoulaki¹,

Sarantopoulos²,

Melemeni³

et al. 2001

Regional Anesthesia and Pain Medicine

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Background and Objectives: Breast surgery for cancer is associated with chronic pain and sensory abnormalities. The present study investigates the effect of regional block, oral mexiletine, and the combination of both, on acute and chronic pain associated with cancer breast surgery.Methods: One hundred patients scheduled for cancer breast surgery received either regional block with 18 mL of 1% ropivacaine intraoperatively and oral mexiletine for the first 6 postoperative days (R ϩ M group), or regional block and placebo (R ϩ PL), or normal saline instead of ropivacaine and mexiletine (PL ϩ M), or normal saline and placebo (PL ϩ PL). Postoperative analgesic requirements were recorded daily. Pain was assessed 0, 3, 6, 9, and 24 hours in the postanesthesia care unit (PACU) and on the second to sixth day postoperatively, at rest, and after movement using the visual analog scale (VAS). Three months after surgery, patients were interviewed for the presence and intensity of pain, abnormal sensations, and analgesic requirements. Results: Regional block reduced the number of intramuscular (IM) injections required the first 24 hours (P ϭ .05), the R ϩ PL group requiring less injections versus the PL ϩ M group (P ϭ .037). Lonarid tablet (paracetamol and codeine) consumption from the second to the fifth postoperative day differed among the 4 groups (P ϭ .0304), the R ϩ M group requiring fewer tablets than the PL ϩ PL group (P ϭ .009). Three hours postoperatively, the R ϩ PL group had less pain at rest when compared with all other groups (P Ͻ .05 for all comparisons). On the second postoperative day, VAS at rest and after movement was less in the R ϩ M versus the R ϩ PL group (P Ͻ .01 and P Ͻ .05, respectively). Three months after surgery, the 4 groups were similar with regard to incidence or intensity of pain or analgesic requirements. The R ϩ PL group had a lower incidence (77%) of reduced or absent sensation (P ϭ .016). Conclusions: Regional block reduced the analgesic requirements in the early postoperative period, while mexiletine combined with regional block reduced the total analgesic requirements during the next 5 postoperative days. Although chronic pain was not affected by these treatments late-abnormal sensation may be diminished by combination of these treatments. Reg Anesth Pain Med 2001;26:223-228.

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Mexiletine as an Adjuvant Analgesic for the Management of Neuropathic Cancer Pain

Cited by 15 publications

References 6 publications

Regional block and mexiletine: The effect on pain after cancer breast surgery

Regional block and mexiletine: The effect on pain after cancer breast surgery

Management Strategies for Pain in Breast Carcinoma Patients: Current Opinions and Future Perspectives

Regional Block and Mexiletine

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