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Multimodal approach to therapy-related neuropathic pain in breast cancer.

PURPOSE
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).


CONCLUSION
The multimodal therapy ensures adequate cancer-related neuropathic pain control with minimal side effects.