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AN UNCONVENTIONAL TREATMENT PATHWAY IN THE MANAGEMENT OF POST MASTECTOMY PERIPHERAL NEUROPATHIC PAIN
ESRA Academy. Tilak D. Sep 8, 2016; 138464
Topic: PAIN THERAPY (ACUTE - CHRONIC)
Disclosure(s): None
Dr. Devendra Tilak
Dr. Devendra Tilak

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Abstract
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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. 
Aim: 
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. 

Methods:

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.

Results:

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.

Conclusions:

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.

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