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(1), 40–45.

To evaluate the effects of multimodal therapy on intensity and relief of treatment-related neuropathic pain in patients with breast cancer

This study consisted of 75 patients with breast cancer who were experiencing neuropathic pain randomly divided into three groups. Group 1 received gabapentin only, starting at 300 mg, titrated up to 3,600 mg/day until an adequate response was obtained. Group 2 received a constant dose of 1,200 mg gabapentin and 100 mg diclofen gradually titrated up. Group 3 received multimodal therapy including 900 mg gabapentin, 100 mg diclofen, and 60 mg M-Eslon. Additional medicine was allowed PRN.

• The study reported on 75 patients with breast cancer experiencing neuropathic pain.
• Median patient age was 44 years.
• Patient gender was not specified directly, but was assumed to be 100% female due to breast cancer population.
• Patients underwent different treatments and therapies for breast cancer.
• At study entry, all patients had pain intensity of at least 5 on a visual analog scale (VAS), and pain duration of at least three months.

• Single site
• Serbia

• Patients were undergoing the transition phase of care after initial treatment.
• The study has clinical applicability for late effects and survivorship.

A randomized, three-group, parallel study design was used.

Modified Brief Pain Inventory questionnaire (VAS/Likert scale)

Group 3 (which received the combination of three medications) achieved the highest level of pain relief; however, there was no significant difference between groups. There was a statistically significant drop in pain intensity for all groups. The largest decrease was achieved at time of the first visit. Side effects increased in intensity over time, and group 2 experienced the most intense side effects.

Multimodal therapy seems to have some benefit on neuropathic pain in patients with breast cancer.

• The study did not include an appropriate control group.
• The study had a small sample, with less than 100 patients.
• The study lacked blinding, and confounding variables were present. Patients were to receive morphine as needed for breakthrough pain; however, breakthrough episodes and opioids used were not evaluated.

Patients with breast cancer would appear to benefit from multimodal therapy including different drugs and dosages to treat their neuropathic pain. Nurses should watch for an increase in side effects at subsequent follow-up visits.