title: Multimodal approach to therapy-related neuropathic pain in breast cancer.
abstract: OBJECTIVE
  This study evaluated the effects of the multimodal therapy (gabapentin-non steroidal anti inflammatory drug [NSAID]-morphine) on intensity and relief of treatmentrelated neuropathic pain in patients with breast cancer.
  
  
  METHODS
  This study involved 75 breast cancer outpatients who had previously undergone anti-neoplastic therapy (surgery, chemotherapy, radiotherapy). The patients were randomly divided into 3 groups, which were formed depending on the planned analgesic therapy (gabapentin, gabapentin- NSAID, gabapentin-NSAID-morphine). Each group was a control group to itself. The pain intensity difference and scores of daily activities were collated and assessed by the modified Brief Pain Inventory (BPI) questionnaire (VAS/Likert Scale). Monitoring the additional medication and side effects optimized the therapy efficiency evaluation.
  
  
  RESULTS
  During this 6-week study, the decrease of pain intensity was significant in all 3 groups (p <0.0001). Although there was intergroup difference, it was statistically not significant (p >0.05). The variant analysis of pain relief showed differences both among and within the groups in the first 3 weeks of the study (F(1)=7.79, p=0.000; F(2)=7.01, p=0.001; F(3) =5.49, p=0.001). The multimodal group needed the least of additional medication and the variant analysis showed a statistically significant difference (p=0.001) from the 4th week of the trial period. The correlation between the increase trend of side effects and the frequency of additional medication was significant (p <0.05).
  
  
  CONCLUSIONS
  The multimodal therapy ensures adequate cancer-related neuropathic pain control with minimal side effects.
authors.affiliation: Oncology Institute of Vojvodina, Department of Surgery, Intensive Care and Pain Therapy Unit, Sremska Kamenica, Serbia.
authors.forename: E
authors.initials: E
authors.lastname: Patarica-Huber
authors.forename: N
authors.initials: N
authors.lastname: Boskov
authors.forename: M
authors.initials: M
authors.lastname: Pjevic
mesh_terms: D000328:Adult; D000368:Aged; D000588:Amines / Q000008:administration & dosage; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D001943:Breast Neoplasms / Q000150:complications / Q000628:therapy*; D003509:Cyclohexanecarboxylic Acids / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D005260:Female; D000077206:Gabapentin; D006801:Humans; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage; D009437:Neuralgia / Q000188:drug therapy* / Q000209:etiology; D005680:gamma-Aminobutyric Acid / Q000008:administration & dosage
chemical_list: D000588:Amines; D000894:Anti-Inflammatory Agents, Non-Steroidal; D003509:Cyclohexanecarboxylic Acids; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin; D009020:Morphine