Chemotherapy Induced Painful Peripheral Neuropathy: A Treatment Option

BACKGROUND: Cancer diagnosis and treatment are tragic issues for patients. Besides the psychological aspects associated with therapeutic interventions, chemotherapy-induced painful peripheral neuropathy (CIPPN) is one of the long-term side effects of intravenous chemotherapeutic agents used to treat cancers. This type of neuropathic pain has not effectively responded to medications for peripheral neuropathy treatment. Duloxetine is effective in decreasing CIPPN. This evidence-based research investigates the practice changes that can be implemented to reduce the pain ratings of survivors with CIPPN. METHODS: In this practice improvement project, patients with CIPPN who reported a rating of ≥3 on the pain scale with the current pain regimen were given duloxetine 30 mg daily for one week and increased to 60 mg daily. The goal is to implement practice changes to decrease painful peripheral neuropathy induced by chemotherapy in cancer survivors. INTERVENTION: Lewin’s Change Theory was used, which provided fundamental principles for change. Lewin’s Change Theory consists of 3 stages: Unfreezing, Change, and Refreezing. The change was implemented with evidence-based research to prove the effectiveness of duloxetine to improve CIPPN using the Plan-Do-Study-Act (PDSA) model for treatment. RESULTS: A total of 9 patients with CIPPN who rated their pain greater or equal to 3 on the pain scale initiated treatment with duloxetine. The project ran for 7 weeks from 1/17/2022 to 3/9/2022. Patients were identified in the first 4 weeks and were asked to revisit 3 weeks later for effective evaluation. The provider contracted COVID-19 during this period, which caused a delay in project completion and reduced the patient population. The mean pain rating was 7.25 for 9 patients on a traditional peripheral neuropathy regimen. However, the duloxetine mean pain rating was 3.125 for 8 patients. A total 4.125-point reduction in pain was noted with duloxetine compared to other therapies. CONCLUSION: Duloxetine was effective in decreasing pain scores in patients with CIPPN compared with other neuropathy regimens. Pain relief provides a sense of well-being and helps patients function physically and mentally