Effect of Early Administration of the N-Methyl-D-Aspartate Receptor Antagonist Amantadine on the Development of Postmastectomy Pain Syndrome: A Prospective Pilot Study

Eisenberg, Elon; Pud, Dorit; Koltun, Lev; Loven, David

doi:10.1016/j.jpain.2006.08.003

Cited by 33 publications

(15 citation statements)

References 32 publications

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“…Because psychosocial status, preoperative breast pain, and acute postoperative pain intensity are well-known risk factors related to a persistent postsurgical pain state, 1,4,5,27,28 large-scale therapeutic interventions in relevant subpopulations are required to outline rational strategies for prevention and treatment. So far, analgesic and other interventions with paravertebral blocks, 29 topical capsaicin, 30 gabapentin and local anesthetics, 31 N-methyl-D-aspartatereceptor antagonists, 32 or glucocorticoids 33 may suggest certain benefits, but large-scale studies including wellcharacterized relevant subpopulations are required before general recommendations can be made. These results and those of other studies 1 clearly show that a persistent postsurgical pain state may be related to existence of other pain syndromes (headache, low back pain), which may suggest that a preoperative general pain hypersensitivity due to psychosocial or genetic factors may be important pathogenic mechanisms, and therefore to be included in future preventive and therapeutic trials.…”

Section: Commentmentioning

confidence: 99%

Prevalence of and Factors Associated With Persistent Pain Following Breast Cancer Surgery

Gärtner¹,

Jensen²,

Nielsen³

et al. 2009

JAMA

764

537

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Context Persistent pain and sensory disturbances following surgical treatment for breast cancer is a significant clinical problem. The pathogenic mechanisms are complex and may be related to patient characteristics, surgical technique, and adjuvant therapy.Objective To examine prevalence of and factors associated with persistent pain after surgical treatment for breast cancer. Design, Setting, and PatientsA nationwide cross-sectional questionnaire study of 3754 women aged 18 to 70 years who received surgery and adjuvant therapy (if indicated) for primary breast cancer in Denmark between January 1, 2005, and December 31, 2006. A study questionnaire was sent to the women between January and April 2008.Main Outcome Measures Prevalence, location, and severity of persistent pain and sensory disturbances in 12 well-defined treatment groups assessed an average of 26 months after surgery, and adjusted odds ratio (OR) of reported pain and sensory disturbances with respect to age, surgical technique, chemotherapy, and radiotherapy.Results By June 2008, 3253 of 3754 eligible women (87%) returned the questionnaire. A total of 1543 patients (47%) reported pain, of whom 201 (13%) had severe pain, 595 (39%) had moderate pain, and 733 (48%) had light pain. Factors associated with chronic pain included young age (18-39 years:

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Section: Commentmentioning

confidence: 99%

Prevalence of and Factors Associated With Persistent Pain Following Breast Cancer Surgery

Gärtner¹,

Jensen²,

Nielsen³

et al. 2009

JAMA

764

537

View full text Add to dashboard Cite

show abstract

“…This may require days or even weeks of titration to target dosage with such medications as duloxetine, gabapentin, or pregabalin. Many prevention studies for CPSP have initiated gabapentin and other oral medications between 1 hour and 1 day prior to surgery [3,12,24,25,27,33,51,52,57,66,95,97,98,101,108,116,131,133,147,148,165]. One study initiated treatment with an antidepressant 2-3 weeks prior to coronary artery bypass surgery; however, chronic pain was only assessed as part of a composite quality of life measure [31].…”

Section: Design Considerations In the Context Of 4 Illustrative Prmentioning

confidence: 99%

“…We suggest that the time period in which post-surgical pain is considered acute should be based on natural history data specific to each surgery model or, in the absence of epidemiological data, the clinical expertise of the investigator. Several clinical trials have extended the investigational treatment between 5 and 14 days post-surgery [3,27,51,52,67,66,95,108,120,133]. …”

Section: Design Considerations In the Context Of 4 Illustrative Prmentioning

confidence: 99%

Research design considerations for chronic pain prevention clinical trials

Gewandter

Dworkin

Turk

et al. 2015

Pain

133

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Although certain risk factors can identify individuals who are most likely to develop chronic pain, few interventions to prevent chronic pain have been identified. To facilitate the identification of preventive interventions, an IMMPACT meeting was convened to discuss research design considerations for clinical trials investigating the prevention of chronic pain. We present general design considerations for prevention trials in populations that are at relatively high risk for developing chronic pain. Specific design considerations included subject identification, timing and duration of treatment, outcomes, timing of assessment, and adjusting for risk factors in the analyses. We provide a detailed examination of 4 models of chronic pain prevention (i.e., chronic post-surgical pain, postherpetic neuralgia, chronic low back pain, and painful chemotherapy-induced peripheral neuropathy). The issues discussed can, in many instances, be extrapolated to other chronic pain conditions. These examples were selected because they are representative models of primary and secondary prevention, reflect persistent pain resulting from multiple insults (i.e., surgery, viral infection, injury, and toxic/noxious element exposure), and are chronically painful conditions that are treated with a range of interventions. Improvements in the design of chronic pain prevention trials could improve assay sensitivity and thus accelerate the identification of efficacious interventions. Such interventions would have the potential to reduce the prevalence of chronic pain in the population. Additionally, standardization of outcomes in prevention clinical trials will facilitate meta-analyses and systematic reviews and improve detection of preventive strategies emerging from clinical trials.

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“…In one study of 19 patients, memantine was found to significantly reduce the incidence and intensity of phantom limb pain in patients undergoing traumatic amputations when used in combination with a regional block [57]. Another study on the effects of amantadine for CPSP found that all patients treated with amantadine developed CPSP (9/9) compared to 75 % of patients who received a placebo (6/8) [58]. Further study of these agents may be warranted.…”

Section: Other Nmda Receptor Antagonistsmentioning

confidence: 99%

Preventive Analgesia and Novel Strategies for the Prevention of Chronic Post-Surgical Pain

Clarke

Poon

Weinrib

et al. 2015

Drugs

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Chronic post-surgical pain (CPSP) is a serious complication of major surgery that can impair a patient's quality of life. The development of CPSP is a complex process which involves biologic, psychosocial, and environmental mechanisms that have yet to be fully understood. Currently perioperative pharmacologic interventions aim to suppress and prevent sensitization with the aim of reducing pain and analgesic requirement in acute as well as long-term pain . Despite the detrimental effects of CPSP on patients, the body of literature focused on treatment strategies to reduce CPSP remains limited and continues to be understudied. This article reviews the main pharmacologic candidates for the treatment of CPSP, discusses the future of preventive analgesia, and considers novel strategies to help treat acute postoperative pain and lessen the risk that it becomes chronic. In addition, this article highlights important areas of focus for clinical practice including: multimodal management of CPSP patients, psychological modifiers of the pain experience, and the development of a Transitional Pain Service specifically designed to manage patients at high risk of developing chronic post-surgical pain. Key PointsThe development of chronic post-surgical pain (CPSP) is a complex process which involves biologic, psychosocial, and environmental mechanisms.Ketamine (an NMDA antagonist) appears to be the pharmacologic agent with the most consistent positive preventive analgesic results.The variation in patient response to pharmacologic agents can be explained, in part, by genetic polymorphisms.Understanding the heritability of CPSP will be useful when developing predictive algorithms to determine the preoperative risk for developing CPSP.Psychological treatments delivered before and after surgery have the potential to influence the trajectory of CPSP from the earliest days, in combination with multimodal, preventive analgesia.

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Effect of Early Administration of the N-Methyl-D-Aspartate Receptor Antagonist Amantadine on the Development of Postmastectomy Pain Syndrome: A Prospective Pilot Study

Cited by 33 publications

References 32 publications

Prevalence of and Factors Associated With Persistent Pain Following Breast Cancer Surgery

Prevalence of and Factors Associated With Persistent Pain Following Breast Cancer Surgery

Research design considerations for chronic pain prevention clinical trials

Preventive Analgesia and Novel Strategies for the Prevention of Chronic Post-Surgical Pain

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