Patarica-Huber, E., Boskov, N., & Pjevic, M. (2011). Multimodal approach to therapy-related neuropathic pain in breast cancer. Journal of B.U.ON.: Official Journal of the Balkan Union of Oncology, 16, 40–45.

The purpose of the study was to evaluate the effects of gabapentin with nonsteroidal anti-inflammatory drugs (NSAIDs) and morphine versus gabapentin alone.

Participants were randomized into three groups. Group 1, consisting of 25 participants, received gabapentin alone, titrated weekly from 300 mg per day to 3,600 mg per day in divided doses. Group 2, consisting of 25 participants, received gabapentin 1,200 mg per day and diclofen 100 mg per day, also titrated over the first week. Group 3, consisting of 25 participants, received gabapentin 900 mg per day, diclofen 100 mg per day, and morphine 60 mg per day all in divided doses. Patients were treated for six weeks and assessed on a weekly basis.

• Seventy-five participants, all women aged 23–74 years (with a median age of 44 years), took part in the study.
• Participants were patients with breast cancer who were previously treated with any combination of chemotherapy, radiation therapy, and surgery, with neuropathic pain occurring post-treatment.
• Additional eligibility requirements included participants having a pain intensity rating of 5 or higher on a visual analog scale, having pain duration of at least three months, being older than age 18, being cognitively intact, having normal renal function, and having no gastrointestinal issues.

This single-site study was conducted in an outpatient setting in Serbia.

Phase of care

• Transition
• Long-term follow-up

Applications

• Late effects
• Survivorship

This study was quasiexperimental.

• Measurement tools included a visual analog scale, a modified Brief Pain Inventory, and the Pain Intensity Difference scale.
• Side effects from the medications used were assessed using a four-point Likert-type scale (0–3), with 0 indicating no side effects and 3 indicating severe side effects.

Participants in all three groups saw diminished pain and diminished influence of pain on their daily activities. No significant difference was noted between groups (p = 0.05).

Although all groups achieved significant pain control, the authors concluded that the multimodal therapy used in group 3 provided the best pain relief with the fewest side effects. However, inconsistency existed regarding doses between groups and, although differences in pain levels in each group diminished over time, between-group differences were not significant. No firm conclusions can be made.

• Limitations include a lack of control group, the potential for bias with no blinding method enacted, and that no valid measure of neuropathy was used.
• Actual dosages used varied from group to group, so clear conclusions are difficult.

The results support a multimodal approach to pain management in patients with breast cancer with neuropathic pain, but are not specific to peripheral neuropathy. The findings do not suggest any difference between the treatments tested in terms of efficacy; however, multiple limitations did exist in the study.