ESRA Academy. Tilak D. Sep 8, 2016; 138464; 0321 Topic: PAIN THERAPY (ACUTE - CHRONIC)
Disclosure(s): None
Dr. Devendra Tilak
Dr. Devendra Tilak

Access to Premium content is currently a membership benefit.

Click here to join ESRA or renew your membership.

Discussion Forum (0)
Rate & Comment (0)
Background and Aims:

Breast cancer is the commonest cancer in women with high incidence(25-60%) of chronic pain. Post-MastectomyPainSyndrome(PMPS) remains well recognised yet poorly treated. In the UK NHS-patients wait at least 6 months after referral to secondary-care to receive treatments like (Qutenza®). 

A prospective-trial over(4-months) at a DGH, staffing two consultant breast-surgeons. 
To assess feasibility of an unconventional treatment-pathway that supported direct referral by the surgical(breast) team for Qutenza® treatment.
To treat patients within 10-weeks of referral.
To confirm, if breast surgical-teams were able to identify patients having PMPS(Post-MastectomyPain syndrome) with predominantly NeP appropriately. 


Breast surgical-team members were trained in the use of questionnaires and identification of NeP and its treatment.
Patient with moderate-to-severe PMPS(VNRS-score >/=6/10), also completed LANSS(LeedsAssessment of NeuropathicSymptoms andSigns) questionnaire with breast teams.
Those with LANSS >/=12/24 were started on gabapentinoids and referred to the chronic pain service for 8% Capsaicin patch treatment (Qutenza®). Patients were given S-LANSS and BPI(short) questionnaires to be completed and sent to Chronic pain department, 6-8 weeks after initiation of gabapentinoids.


All 7-patients recruited for Qutenza®, had NeP.

6-patients received Qutenza® 7.8-weeks(SD-1.17) after referral. 1/7-patients was satisfied with gabapentinoids and left, rest stopped gabapentoids before or soon-after Qutenza®-treatment. Average time from onset of pain to Qutenza® was 15.8-months(range 6-26months)

Patients had average post-treatment VNRS-1.5(S.D-1.4) compared to pre-treatment VNRS-score of 7.8/10(S.D-1.1). All patients had improved-QOL and ability to perform-ADL's, with good to excellent satisfaction.


Robust patient-centres clinical-pathway can achieve early recognition and appropriate treatment NeP. 
Reduce waiting times and disease burden for patients and clogging up pain clinics.

Code of conduct/disclaimer available in General Terms & Conditions
Anonymous User Privacy Preferences

Strictly Necessary Cookies (Always Active)

MULTILEARNING platforms and tools hereinafter referred as “MLG SOFTWARE” are provided to you as pure educational platforms/services requiring cookies to operate. In the case of the MLG SOFTWARE, cookies are essential for the Platform to function properly for the provision of education. If these cookies are disabled, a large subset of the functionality provided by the Platform will either be unavailable or cease to work as expected. The MLG SOFTWARE do not capture non-essential activities such as menu items and listings you click on or pages viewed.

Performance Cookies

Performance cookies are used to analyse how visitors use a website in order to provide a better user experience.

Google Analytics is used for user behavior tracking/reporting. Google Analytics works in parallel and independently from MLG’s features. Google Analytics relies on cookies and these cookies can be used by Google to track users across different platforms/services.

Save Settings