Lambertini, M., Del Mastro, L., Bellodi, A., & Pronzato, P. (2014). The five “Ws” for bone pain due to the administration of granulocyte-colony stimulating factors (G-CSFs). Critical Reviews in Oncology/Hematology, 89, 112–128.
DOI Link
Purpose & Patient Population
PURPOSE: To determine the effectiveness of antihistamine use with granulocyte-colony stimulating factors (GCSFs)
TYPES OF PATIENTS ADDRESSED: Oncology patients receiving chemotherapy and stem cell donors
Type of Resource/Evidence-Based Process
RESOURCE TYPE: Consensus-based guideline
SEARCH STRATEGY: None identified
DATABASES USED: None identified
KEYWORDS: None identified
INCLUSION CRITERIA: Patients receiving chemotherapy with a moderate to high risk for neutropenia; stem cell donors
EXCLUSION CRITERIA: None identified
Phase of Care and Clinical Applications
PHASE OF CARE: Active antitumor treatment
APPLICATIONS: Elder care
Results Provided in the Reference
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Six studies looking at the incidence of bone pain associated with GCSFs in cancer patients evaluating diagnosis, dosing, and incidence
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Five studies looking at incidence of bone pain associated with GCSFs in healthy people evaluating dose and incidence
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Three studies involving elderly patients with lymphoma who received GCSFs evaluating chemotherapy regimens with or without GCSFs and incidence
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Six studies evaluating the prevention and treatment of bone pain with GCSFs in varying forms of interventions with a maximum of two studies looking at opioids, one with no reported relief of pain
Guidelines & Recommendations
There was no real difference between pegfilgrastim and daily GCSFs in terms of incidence of bone pain, and most patients will benefit from the use of NSAIDs to control pain. The authors suggest that patients who do not respond to NSAIDs should consider second-line treatment with antihistamines. The study cites a series of four patients and one case study in which this was effective.
Limitations
Only one study was cited that evaluated the efficacy of antihistamines in relieving or decreasing bone pain associated with GCSFs from 2005. Main evidence is case reports only.
Nursing Implications
More studies are needed to evaluate the efficacy of antihistamines versus NSAIDs or acetaminophen in relieving bone pain.