Pentoxifyllin in animal models

In an animal model pentoxifylline could reduce neuropathic pain^[1] And pentoxifylline displayed to be more effective in a neuropathic pain model, than in animals with acute painb.^[2] Pentoxifylline inhibits the following molecules: TNF-α, IL-1β en IL-6.^[3] The effect of pentoxifylline in patients is hardly described. One case report of a patient with diabetic pain responded well on pentoxifylline.^[4]

Clinical studies on pentoxifylline

Cytokine release during surgery can produce a long-lasting hyperalgesia. Thus, preoperatively-administered cytokine inhibitors might reduce the production of cytokines, decreasing central nervous system sensitization and improving the quality of postoperative pain relief.

Forty patients were randomly assigned to 1 of 2 groups of 20 each: the PTX group relatieve a PTX 5 mg/kg IV infusion before the induction of anesthesia, whereas the control group received an equal volume of normal saline. Venous blood samples were obtained at frequent intervals.

After surgery, all patients received patient-controlled analgesia (PCA) morphine for postoperative pain relief. Patients in the PTX group exhibited longer PCA trigger times, less morphine consumption, and a faster return of bowel function compared with patients in the control group.

Moreover, the plasma levels of IL-6, IL-8, and IL-1 receptor antagonist were less in the treatment group, and there was no significant difference in wound infections, tumor recurrence, or metastatic rates between groups during a 2-yr follow-up.^[5] 

Another studie examined the effect of pentoxifylline on pain after radiation. Also in this study clear pain reduction was observed

In an open label drug trial, pentoxifylline (400 mg orally tid for 8 weeks) was given to 30 patients who displayed late, radiation-induced fibrosis at 1 to 29 years posttreatment (40 to 84 Gy).

The results:

Patients receiving pentoxifylline demonstrated improved on various scales, in muscle strength and decreased limb edema and pain. Reversal of these delayed radiation effects was associated with a decrease in circulating FGF2.^[6] 

November, 2010 David J. Kopsky, MD and prof.dr. Jan M. Keppel Hesselink MD, PhD

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