title: Prospective study of neuropathic pain after definitive surgery for extremity osteosarcoma in a pediatric population.
abstract: Neuropathic pain (NP) after definitive surgery for extremity osteosarcoma (OS) has not been previously characterized. This study prospectively investigates the incidence, duration, and treatment of NP in limb sparing surgery and amputation groups.
  
  
  
  In patients treated for OS on a chemotherapy and definitive surgery (limb sparing vs. amputation) protocol (OS08), we prospectively collected the following data: (i) demographical data (age, sex, race); (ii) NP time of onset and duration; and (iii) dose (starting, maximum) and duration of gabapentin, amitriptyline, and methadone treatment.
  
  
  
  Thirty-seven patients underwent 38 definitive surgeries: limb sparing (26, 68.4%) or amputations (12, 31.6%). Localization included lower extremity (30, 81%), upper extremity (6, 16%), or pelvis (1, 3%). Thirty patients (81%) developed NP and 26 of them required NP-specific medications (87.7%). The mean [standard deviation (SD)] duration of NP was 6.5 weeks (7.2) (median 4.4, range 0.3-29.9). All 26 patients (27 surgeries) treated with NP medications received gabapentin, either as single therapy (65.4%) (17 patients, 18 surgeries), dual therapy with gabapentin and amitriptyline (five patients), or triple therapy with gabapentin, amitriptyline, and methadone (four patients). The mean starting (maximum) doses of gabapentin, amitriptyline, and methadone (mg/kg/day) were 20.2 (43.8), 0.5 (0.7), and 0.3 (0.3), respectively. The incidence and duration of NP, duration of treatment, and NP-specific dose regimens were similar in the limb sparing and the amputation groups.
  
  
  
  NP after definitive surgery for OS is frequently encountered, can persist for a significant time, and NP outcomes are similar in limb sparing and amputation groups.
authors: Pain Management Service, Division of Anesthesiology, Department of Pediatric Medicine, St Jude Children's Research Hospital, Memphis, Tennessee.
authors: Doralina L
authors: DL
authors: Anghelescu
authors: Department of Anesthesiology, St Jude Children's Research Hospital, Memphis, Tennessee.
authors: Brenda D
authors: BD
authors: Steen
authors: Department of Biostatistics, St Jude Children's Research Hospital, Memphis, Tennessee.
authors: Huiyun
authors: H
authors: Wu
authors: Department of Biostatistics, St Jude Children's Research Hospital, Memphis, Tennessee.
authors: Jianrong
authors: J
authors: Wu
authors: Division of Pediatrics, MD Anderson Cancer Center, Houston, Texas.
authors: Najat C
authors: NC
authors: Daw
authors: Department of Surgery, St Jude Children's Research Hospital, Memphis, Tennessee.
authors: Bhaskar N
authors: BN
authors: Rao
authors: St. Jude Children's Research Hospital, Memphis, Tennessee.
authors: Michael D
authors: MD
authors: Neel
authors: Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee.
authors: Fariba
authors: F
authors: Navid
mesh_terms: D000293:Adolescent; D001859:Bone Neoplasms / Q000150:complications / Q000601:surgery*; D005121:Extremities / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009437:Neuralgia / Q000175:diagnosis / Q000209:etiology*; D012516:Osteosarcoma / Q000150:complications / Q000601:surgery*; D010149:Postoperative Pain; D011379:Prognosis; D011446:Prospective Studies
keywords: amputation; limb sparing; neuropathic pain; osteosarcoma