those with severe joint and limb pain on femara,aromasin (?and arimidex?)

[Lani]

There may be visible changes on ultrasound, MRI which correlate with your symptoms ie, they may not just be in your head. This study only looked at those that complained a lot about these symptoms, so its unclear if they represent everyone taking these medications. But this study may be worth showing your oncologist. I will try to get the full article to see why arimidex was not listed, but I think it is because the study is out of Belgium--in the EU femara seems to be used much more than arimidex

Jean--this is just the start of many articles which will surely be coming out which I hope will answer your question.

Posted on the main board as I assumed its wider readership would get this information out to more who might find it helpful:

1: Breast Cancer Res Treat. 2006 Oct 24; [Epub ahead of print] Links
Debilitating musculoskeletal pain and stiffness with letrozole and exemestane: associated tenosynovial changes on magnetic resonance imaging.

Morales L,
Pans S,
Paridaens R,
Westhovens R,
Timmerman D,
Verhaeghe J,
Wildiers H,
Leunen K,
Amant F,
Berteloot P,
Smeets A,
Van Limbergen E,
Weltens C,
Van den Bogaert W,
De Smet L,
Vergote I,
Christiaens MR,
Neven P.
Department of General Medical Oncology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium.
OBJECTIVE: Arthralgia, skeletal and muscle pain have been reported in postmenopausal women under treatment with third generation aromatase inhibitors (AIs). However, the pathogenesis and anatomic correlate of musculoskeletal pains have not been thoroughly evaluated. Moreover, the impact of AI-induced musculoskeletal symptoms on normal daily functioning needs to be further explored. PATIENTS AND METHODS: We examined 12 consecutive non-metastatic breast cancer patients who reported severe musculoskeletal pain under a third generation AI; 11 were on letrozole and 1 on exemestane. Clinical rheumatological examination and serum biochemistry were performed. Radiological evaluation of the hand/wrist joints were performed using ultrasound (US) and/or magnetic resonance imaging (MRI). RESULTS: The most common reported symptom was severe early morning stiffness and hand/wrist pain causing impaired ability to completely close/stretch the hand/fingers and to perform daily activities and work-related skills. Six patients had to discontinue treatment due to severe symptoms. Trigger finger and carpal tunnel syndrome were the most frequently reported clinical signs. US showed fluid in the tendon sheath surrounding the digital flexor tendons. On MRI, an enhancement and thickening of the tendon sheath was a constant finding in all 12 patients. CONCLUSIONS: Musculoskeletal pains in breast cancer patients under third generation AIs can be severe, debilitating, and can limit compliance. Characteristic tenosynovial, and in some patients joint changes on US and MRI were observed in this series and have not been reported before.
PMID: 17061044 [PubMed - as supplied by publisher]

[Jean]

Lani,
Many thanks again - I am so eager for news on this matter.

Jean

[Montana]

I will be printing this out for my onc visit next month. These symptoms are mine exactly. I am on celebrex 100 mg/day but twice a day would be better. I had to beg for the celebrex.

[CherylS]

Good to see something that looks like substantiated evidence (It's not all in our heads!) I began 200 mg. once a day of Celebrex about 3 weeks ago. So far no improvement. Anyone had success with Celebrex? Also, does anyone know if Celebrex can alter the CA27.29 like some other meds?

[Montana]

Cheryl, The Celebrex only works while you are taking it and I felt better after the first pill. It helps my joints loosen up in the morning and I have a lot less joint and burning/shooting bone pain from Arimidex. I think you can take 200 mg twice or three times daily if needed. My 100 mg wears off by mid-afternoon. I believe there could be liver damage for some people taking larger doses. Check with your doctor.

[Her2nSue]

Cheryls, I've had such severe muscle pain and joint stiffness since starting Femara and having Herceptin alone once every 3 weeks. The Onc prescribed Celebrex which I have taken faithfully every morning. Doesn't seem to do too much in the way of eliminating the pain. I've been telling the Onc this since he prescribed Celebrex back in May. Only last week did he seem to wake up when I told him the pain is 24/7 and stiffness may loosen up while I am up and about, but sit or drive longer than 25 minutes and I get up like an old woman (I'm only 50). He prescribed 25 mg of AMITRIPTYLINE, I take a 1/2 tablet in the evening before bed. I've been on it since Sat. 10/21/06 and I do feel a difference. I still have a few sore big joints, but the pain is now not as sharp. Also has worked wonders on my thumb joints. I don't get that sharp burning pain up the arm if I used my thumbs. Ask you're Onc. about it. The pharmacy said that the prescription is actually a mild antidepressant, but that the doctors have been using it to help with pain, too. Good Luck.

dx:
Oct. 3, 2005
IDC
1ct, grade 2
ER & PR+
Her2+++
Left simple mastect.10/18
no nodes involved
reconstruction 6/05

11/05 started with A/C -1 every 3 wks.
Taxol & Herceptin -1 ea. week for 12 weeks.
now just Herceptin till 2/07

[chrislmelb]

Can anyone tell me the actual drug name? Re Amitriptaline, i was prescribed it when i had chronic back pain many years ago. Can't remember if it was great as i took anti inflammatories too. Very old fashioned anti-depressant too but then they can be better than the newer ones in some situations. i might research this one as i am sick of feeling like an old achy woman when i am only 43.
Christine

[Roz]

Christine, I am fairly certain that Celebrex is available in Australia. However, wasn't there some recent controversy over it (something to do with heart attack--or this may have been another drug). You can look it up on the Pharmaceutical Benefits site (or ask your doc)
Cheers
Roz

[Her2nSue]

I believe the prescription name was Elivan (sp?) The pharmacist uses the other name, which I can't spell unless the bottle is under my nose. I hope this helps you out.

Sue

[Her2nSue]

Chrislmelb,

I believe that the real name for the drug is Elevan that was on the priscription. The pharmacist gave it the Amitriptaline name. I'm also taking that along with Celebrex. I don't understand why, since I really had no affects from it. I hadn't realized that Celebrex can also cause heart problems. That sure is nice to know. Thanks. Hope my info. on drug name is helpful.

Sue

[Marlys]

Vioxx is the drug that was taken off the market because of cardiac problems (like death). Celebrex is a similar drug and because of this my internist had me stop taking it. I believe that Naproxan is another drug with some of these problems. That is the generic name of Aleve.
Someone correct me if I'm wrong.
Marlys

[Petesmom]

I have been taking Cymbalta 30mg for about 4 months now for the joint pain I have experienced while taking Arimidex. I could not believe how much better I felt after 3 days on this drug. It has definitely made a difference in the way I feel.

Petesmom

[Marlys]

Petesmom,
I was interested that an antidepressant was prescribed for joint pain so decided to "google" it and found this. I am a retired nurse and like to keep up on things like this. When I decided to quit smoking my doctor prescibed Wellbutrin to help me and it worked. I have been smoke free for almost 8 years. And now here comes another miracle use for an antidepressant. I have some arthritic changes anyway and Arimidex hasn't improved that so I am considering asking my internist what she thinks about Cymbalta.
Thanks for the info.
Marlys
PS: Elavil is the name for amiltryptiline
http://www.medicalnewstoday.com/medicalnews.php?newsid=15180

[Jean]

Today I had an appointment with a neurologist for the neuropathy in my toes.
My onc. had prescribed Gabapentin 100mg. 3x daily, said it takes time to work, I started the Gabapentin 8/06 and to date no help at all. That is when I decided to consult with a neurologist. He recommended Cymbalta for the neuropathy (I did not even discuss the joint and muscle aches of Femara)
since I was seeing him for the neuropathy. So after reading this article I now am hopefull I will be able to slove both problems with Cymbalta.

I spoke with Dr. Slamon this eveing upon return from the appointment with
the neurologist and we also discussed Celebrex and he told me that Celebrex
would NOT be advisable due to the heart issues - and a major issue since
I am on herceptin (will be on herceptin for the rest of the year).

The neurologist explained to me that while using Cymbalta for depression
they discovered it had a strong benefit for sensitivite neuropathy. I have
been told by onc. here and Dr. Slamon that the neuropathy will take 6 months to 9 months to clear up -

I have started the Cymbalta today at 30 mg. for seven days and then
the second week 60 mg. (I sure do hope it will ease up the neruopathy)
since it has been rather uncomfortable and painfull for walking and being on my feet. Now if I also receive some comfort from the aches and joint
pain....well that sounds fine also.

Will keep you updated.
That's All Folks!

Jean

[chrislmelb]

I remember a while ago someone singing it's praises for reduced joint problems. Only problem is we can't get it here. It is in the same family as Effexor (SNRI) so now i am wondering how people on Effexor are finding the aches and pains?????
Christine

[panicked911]

I have been on glucosimine and controitin ( osteobioflex brand triple strength) and it has helped. Not as stiff and also doing physical therapy - which has helped as well. Strnge thing though, I can "feel it" moving thru my body the terrible joint and muscle pain started in the legs, ankle and knees was there for a few months- it started to elt up and now it is in the hands and fingers . still achy all over but the hands ( thus my crappy typing) are clearly the worst.

HAS ANYONE ELSE HAD THIS EXPERIENCE?

Susanne

[R.B.]

If you have not thought about it you may like to look at the omega three six posts.

There are several trials suggesting that higher levels of omega three help in arthritis etc. High omega six is connected with inflamatory conditions.

Aromatase blockers work in general areas of fat pathways as one of their effects.

IF they are blocking long chain fat making ability in any way the only option is to get them (DHA EPA etc) through diet, which for omega threes means oily fish etc.

You can search by clicking on the search bar above and entering your search term.

Fats are ver powerful. Please consult with your advisors before making significant dietary adjustements.

RB

[Petesmom]

Marlys,

The article that I found on Cymbalta and its use to treat pain in Fibromyalgia can be viewed by clicking the following link:

http://www.medscape.com/viewarticle/536239_2

I think you will find it interesting.

Petesmom

[Soccermom]

I too suffer from trigger fingers, joint pain etc. Was on Tamoxifen for 5 mo and switched to Arimidex when it was clear that i was menopausal permanently. Fewer hot flashes BUT more joint pain. Was going to switch again to Femara but according to what I have read here pain issues will be similar...so whats the point? I have been using Duragesic12.5 mcg since June 2005 for rotator cuff issues associated w bilat masts. Also use oral pain meds when I have significant breakthru. I work in retail and stand on my feet continuously. Also putting merchandise away is my PT (LOL) but by the end of the day I simply cannot lift my arms very high.
Thats my story and I am sticking to it! LOL

Marcia

[Lisa1962]

I too suffer from severe muscle and joint pain - but I've stopped mentioning them to my doctor - she looks at the medications I am on and just tells me that they're not side-effects...

I'm going to print this out and bring it when I go in a few months

[Ora]

I am a little confused. I take Effexor (actually the generic Venlafaxine 37.5 mg) for hot flashes and it also seems to be a pretty good anti-depressant. I take glucosomine & chondroitin (sp) for joint & back pain which my doctor lets me augment with a pain pill occasionally just so I can keep working. (Hope to retire end of year- hope & pray) But I do have neuropathy in toes and balls of my feet. Does anyone know if Cymbalta helps with hot flashes? I guess if I have to make the choice between living with hot flashes or numb tootsies, I'd have to go with the numbness because I cannot stand the hot flashes.

But the numbness does seem to be spreading up my feet. One of the ladies at my clinic is numb up past her ankles and cannot drive anymore. One more bad thing to worry about.

[Kaye]

Hi--I am one who began to get joint and bone pain with Arimidex. I have been on it 4+ yrs. I started taking Celebrex about 8 mos. after I started it. The Celebrex basically eliminated any pain associated with it and I have no bone related problems (associated with any type of arthritis) as far as I know.
Other thoughts about what might help--how about Glucosamine/Condroitin. I know several on that and they 'swear' by it. We have given it to our 14+ yr old dog who was having a hard time moving around. She now jumps and runs like a much younger dog.
In addition I recently read that the spice Cumerin (Turmeric) may have some anti-inflammatory/anti-arthritis benefits. It can be purchased in the spice section or in capsule form at health food stores. It can also be found in package-form at stores that sell foods from India.
If one uses Turmeric or Cumerin, however, it should not be used with certain chemotherapies--C or M of CMF or Adriamycin. Before using any alternatives, one should discuss with their oncologists and/or other physicians.

[Soccermom]

Dear Ora, I just got my new RX for Cymbalta filled. i asked my onc at my checkup yesterday to switch me from Prozac after I read here that it may help with neuralgias. I will post after I have been on it for awhile and let you know about the hot flashes...you may have to REMIND me tho (LOL).

Marcia

[Jean]

Have been on Cymbalta for three weeks now and the difference is just
amazing! Joint pain is almost gone and muscle pain is gone. Toes are
feeling much improved and the discomfort of the tingling is reduced.
Started taking the Cymbalta for my toes and was surprised that I was getting
relief from the muscle and joint ache (I am taking Femara).

Worth taking to relieve the joint and muscle pain from AI's.

Jean

[Soccermom]

Dear Jean,
What wonderful news regarding pain relief! I am looking forward to experiencing the same ...Yahoo for you!!!

Marcia

[Kim in CA]

Hi,

I have been on Femara for over 4 yrs now. I must say that I used to have pretty severe joint pain and lots of leg cramping. I used to take Glucosamine and Chondroitin, and thought I couldn't live without it, but noticed over the last couple of years that as I have become more active and fit my pains have all but quit. I don't take any joint supplements anymore. I think too, that the further out we get from our chemo the better things get. My last chemo was in 2003. So maybe things will improve with time.

Kim in CA

[Jean]

Kim,
I do agree that the further out we go from chemo the less aches and pains.
But I will note that prior to chemo I was on Arimidex for one year and the
joint pain was rather strong. I continued to exercise (which I believe is
an important key in pain control) but even without chemo I was suffering.
Also take Cosamin/Chondroitin supplements but it did not ease up the pain.
The AI's do effect the body joints and muscle. I would say that anyone that has tried all the natural methods and foods and still experience strong pain should consider the Cymbalta.

Good Luck to all!
Jean

[Soccermom]

Hi all! I am beginning my third week on Cymbalta and have not noticed any change in hot flashes nor pain,as yet. Will keep you posted!

Marcia

[Chelee]

This has been my complaint to my oncologist since I started Femara. The first month no problems...but half way through the second one major aches, pains, stiffness. I feel like I am 105 yrs old.

I told my onc that I am so misrable on Femara, I don't even know if its worth it? She told me to give it time and my body would adjust. It only gets worse...not better. I am certainly taking this article to show her.

Chelee

[Jean]

I think (don't know for sure) that Cymbalta would have any effect on hot flashes, since that is a hormonal reaction. But for me (I am now on Femara)
it has helped greatly with the joint and muscle pain. Prior to taking the
Cymbalta I would also say that the joint and muscle pain was greater for me while I was on Arimidex.

Jean

[Susan Rankin]

Hi,

I asked my oncologist to give me a prescription for Cymbalta as I had read it helped joint pain, musculoskeletal pain, neuropathy, etc. He gave me a prescription for 60 mg a day. I have been taking it for a month. I immediately noticed a huge difference in my joint and muscle pain. I am feeling so much better. I cannot believe the difference in the way I feel. I am not stiff in the mornings, joint pain has subsided, it really is amazing.

I started with Arimidex in May of 2005. I took it for a year and then switched to Femara hoping the joint and muscle pain would improve. The joint pain did not improve with Femara. I am now taking the Femara with the Cymbalta and feeling good.

I was taking Zoloft for an antidepressant but I weaned myself off of this drug when starting the Cymbalta (antidepressant). I have had great results with the Cymbalta as an antidepressant also.

I can't wait to tell my oncologist the difference it has made in my quality of life.

Susan

[Marlys]

I started Cymbalta 30mgm at bedtime a week ago and the results are dramatic. I am glad I read about it here.
Marlys