Arthralgia and Myalgia Intervention Guide

 

Provide education on arthralgias and myalgias

Assess discomfort

Help patient in identifying areas of discomfort

Instruct patient in nonpharmacologic intervention for comfort (see below)*

 

Provide medication as ordered (see below)**

 

Provide written information and instructions about how to manage arthralgias and myalgias and when to notify healthcare professional

 

*Exercise warmth, and massage are part of the nonpharmacologic interventions recommended for these symptoms

*Similar to supportive treatment for arthritis, all of these methods help to relieve the discomfort ofjoint and muscle aches

*Warm baths and application of heating pads to affected areas for brief intervals provide relief to patients

. (Patients also report that remaining active and regular moderate walking are helpful to maintain normal activity function.

 

 

**Medications Used to Treat

Arthralgias and Myalgias

Extra strength Acetaminophen 1 to 2 tablets q4-6h

Naproxen 750-1500 mg/day, or given prophylactically the first 5 days after treatment

Tramadol 50-100 mg q4h prn

Methylprednisolone DOSE PAK (as per package instruction, start 24 hours after treatment)

Hydrocodone I tablet q3-4h prn

Oxycodone 5 mg q6h prn

Vicodin 1-2 tablets q4-6h prn

 

 

 

Class

Drug

Usual Starting Dose

Usual Effective Dose

Schedule

Anticonvulsants

Gabapentin

300mg/d

330mg-3600mg/d

Q 8 hr

 

Carbamazepine

200mg/d

600-1200mg/da

Q 6-8hr

Antidepressants:TCA

Amitriptyline

10-25mg/d

50-150mg/da

Q hs

 

Clomipramine

10-25mgId

50-150mg/da

Q hs

Antidepressants SSRI

Paroxetine

20mg/da

20mg/da

qd

 

Sertraline

50 mg/da

150mg-200mg/da

Divided doses

Topicals

EMLA cream

Lidoderm transdermal patch 5%

 

 

PRN

Up to 3 patches

Opioids

Morphine, Fentanyl

Dose determined by patient tolerance and effect

 

 

Possible Prevention

Glutamine

10mg tid starting 24hr after paclitaxel

10mg tid

Tid x 3-4 days

 

 

References:

Abraxane Canadian Product Monograph, June 2006

http://www.fda.gov/cder/foi/2005/021660lbl.pdf. Accessed September 18, 2006

Almadrones LA and Arcot R (1999) Patient Guide to Peripheral Neuropathy ONF 26(8):1359-1362

Armstrong TA, Almadrones L, Gilbert M (2005)Chemotherapy-induced peripheral neuropathy ONF 32(2): 305-311

Brandt JM (1998) Cancer-Related Neuropathic Pain Nurse Practitioner Forum 9(3):154-162

Taxol Prescribing Information Bnstol Myers Squibb Available at: hppt:www//www.accessdata.fda.gov/scripts/cder/onctools/labels.cfm

Accessed September 18, 2006

Wilkes GM (2003) Neurologic Disturbances:Peripheral Neuropathy in Yarbro CM, Frogge MH, and Goodman M Eds Cancer Symptom Management, 3rd  Ed Sudbury MA: Jones and Bartlett Publishers, pp. 77-96