title: Memantine before Mastectomy Prevents Post-Surgery Pain: A Randomized, Blinded Clinical Trial in Surgical Patients.
abstract: BACKGROUND
  Neuropathic pain following surgical treatment for breast cancer with or without chemotherapy is a clinical burden and patients frequently report cognitive, emotional and quality of life impairment. A preclinical study recently showed that memantine administered before surgery may prevent neuropathic pain development and cognitive dysfunction. With a translational approach, a clinical trial has been carried out to evaluate whether memantine administered before and after mastectomy could prevent the development of neuropathic pain, the impairment of cognition and quality of life.
  
  
  METHODS
  A randomized, pilot clinical trial included 40 women undergoing mastectomy in the Oncology Department, University Hospital, Clermont-Ferrand, France. Memantine (5 to 20 mg/day; n = 20) or placebo (n = 20) was administered for four weeks starting two weeks before surgery. The primary endpoint was pain intensity measured on a (0-10) numerical rating scale at three months post-mastectomy.
  
  
  RESULTS
  Data analyses were performed using mixed models and the tests were two-sided, with a type I error set at α = 0.05. Compared with placebo, patients receiving memantine showed at three months a significant difference in post-mastectomy pain intensity, less rescue analgesia and a better emotional state. An improvement of pain symptoms induced by cancer chemotherapy was also reported.
  
  
  CONCLUSIONS
  This study shows for the first time the beneficial effect of memantine to prevent post-mastectomy pain development and to diminish chemotherapy-induced pain symptoms. The lesser analgesic consumption and better well-being of patients for at least six months after treatment suggests that memantine could be an interesting therapeutic option to diminish the burden of breast cancer therapy.
  
  
  BACKGROUND
  Clinicaltrials.gov NCT01536314.
authors.affiliation: CHU Clermont-Ferrand, Inserm CIC 1405, Centre de Pharmacologie Clinique, F-63003 Clermont-Ferrand, France.
authors.forename: Véronique
authors.initials: V
authors.lastname: Morel
authors.affiliation: Centre Jean Perrin, Centre de Lutte contre le Cancer, 58 rue Montalembert, F-63000 Clermont-Ferrand, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Joly
authors.affiliation: Centre Jean Perrin, Centre de Lutte contre le Cancer, 58 rue Montalembert, F-63000 Clermont-Ferrand, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Villatte
authors.affiliation: CHU Clermont-Ferrand, Inserm CIC 1405, Centre de Pharmacologie Clinique, F-63003 Clermont-Ferrand, France.|Clermont Université, Université d'Auvergne, Pharmacologie Fondamentale et Clinique de la Douleur, Laboratoire de Pharmacologie, Facultés de Médecine/Pharmacie, F-63000 Clermont-Ferrand, France.|Inserm, U1107 Neuro-Dol, F-63001 Clermont-Ferrand, France.
authors.forename: Claude
authors.initials: C
authors.lastname: Dubray
authors.affiliation: Centre Jean Perrin, Centre de Lutte contre le Cancer, 58 rue Montalembert, F-63000 Clermont-Ferrand, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Durando
authors.affiliation: Clermont Université, Université d'Auvergne, Pharmacologie Fondamentale et Clinique de la Douleur, Laboratoire de Pharmacologie, Facultés de Médecine/Pharmacie, F-63000 Clermont-Ferrand, France.|Inserm, U1107 Neuro-Dol, F-63001 Clermont-Ferrand, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Daulhac
authors.affiliation: CHU Clermont-Ferrand, Pharmacie Hospitalière, secteur Recherche Clinique - 58, rue Montalembert, F-63003 Clermont-Ferrand, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Coudert
authors.affiliation: CHU Clermont-Ferrand, Inserm CIC 1405, Centre de Pharmacologie Clinique, F-63003 Clermont-Ferrand, France.
authors.forename: Delphine
authors.initials: D
authors.lastname: Roux
authors.affiliation: CHU de Clermont-Ferrand, Délégation Recherche Clinique & Innovation - Villa annexe IFSI, 58 Rue Montalembert, F-63003 Clermont-Ferrand cedex, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Pereira
authors.affiliation: CHU Clermont-Ferrand, Inserm CIC 1405, Centre de Pharmacologie Clinique, F-63003 Clermont-Ferrand, France.|Clermont Université, Université d'Auvergne, Pharmacologie Fondamentale et Clinique de la Douleur, Laboratoire de Pharmacologie, Facultés de Médecine/Pharmacie, F-63000 Clermont-Ferrand, France.|Inserm, U1107 Neuro-Dol, F-63001 Clermont-Ferrand, France.
authors.forename: Gisèle
authors.initials: G
authors.lastname: Pickering
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D008408:Mastectomy / Q000009:adverse effects*; D008559:Memantine / Q000627:therapeutic use*; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy*; D010865:Pilot Projects; D010919:Placebos; D016037:Single-Blind Method
chemical_list: D010919:Placebos; D008559:Memantine