Can bone pain be avoided during chemotherapy and pegfilgrastim?

This study examined whether loratadine (Claritin) or naproxen (Aleve) is better at treating bone pain associated with G-CSF treatment for patients undergoing chemotherapy for early stage breast cancer. This study concluded that there was no significant difference between the incidence of bone pain reported by patients taking loratadine, naproxen or no prophylactic treatment, but loratadine is recommended for its potential benefit. 

Chemotherapy is often used in breast cancer treatment, but can cause low white blood cell counts. Granulocyte-stimulating colony factor (G-CSF) can be given with chemotherapy. G-CSF is a naturally occurring protein which stimulates the growth of white blood cells in bone marrow. Treatments such filgrastim are used to address the low white blood cell counts and act as G-CSF in the body. However, bone pain can occur as a side-effect from G-CSF use. 

Naproxen or loratadine can be used prophylactically (before the side-effect occurs).  Naproxen is a non-steroidal anti-inflammatory drug, which is also used as a painkiller. Loratadine is an anti-histamine, which can also be used for hayfever allergies. It is unclear whether loratadine or naproxen is better at treating bone pain.  

This study evaluated 600 patients who had early stage breast cancer. The patients were divided into three groups and were randomized to receive loratadine, naproxen or no prophylactic treatment.

There was no significant difference between bone pain reported by any of the groups. The severity of bone pain, as reported by patients, was lower for patients who took naproxen or loratadine. Loratadine was associated with fewer side effects and discontinuations than naproxen.

 This study concluded that there was no significant difference between the incidence of bone pain reported by patients taking loratadine, naproxen or no prophylactic treatment, but loratadine is recommended for its potential benefit and low side effects. 

Other studies have reported benefits with the use of naproxen or loratadine. 

Discuss starting any over-the-counter treatment with your doctor.