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Multicenter Study
. 2017 Mar;64(3):10.1002/pbc.26162.
doi: 10.1002/pbc.26162. Epub 2016 Aug 30.

Prospective study of neuropathic pain after definitive surgery for extremity osteosarcoma in a pediatric population

Doralina L Anghelescu  1 , Brenda D Steen  2 , Huiyun Wu  3 , Jianrong Wu  3 , Najat C Daw  4 , Bhaskar N Rao  5 , Michael D Neel  6 , Fariba Navid  7
Affiliations
Multicenter Study

Prospective study of neuropathic pain after definitive surgery for extremity osteosarcoma in a pediatric population

Doralina L Anghelescu et al. Pediatr Blood Cancer. 2017 Mar.

Abstract

Background: Neuropathic pain (NP) after definitive surgery for extremity osteosarcoma (OS) has not been previously characterized. This study prospectively investigates the incidence, duration, and treatment of NP in limb sparing surgery and amputation groups.

Procedure: In patients treated for OS on a chemotherapy and definitive surgery (limb sparing vs. amputation) protocol (OS08), we prospectively collected the following data: (i) demographical data (age, sex, race); (ii) NP time of onset and duration; and (iii) dose (starting, maximum) and duration of gabapentin, amitriptyline, and methadone treatment.

Results: Thirty-seven patients underwent 38 definitive surgeries: limb sparing (26, 68.4%) or amputations (12, 31.6%). Localization included lower extremity (30, 81%), upper extremity (6, 16%), or pelvis (1, 3%). Thirty patients (81%) developed NP and 26 of them required NP-specific medications (87.7%). The mean [standard deviation (SD)] duration of NP was 6.5 weeks (7.2) (median 4.4, range 0.3-29.9). All 26 patients (27 surgeries) treated with NP medications received gabapentin, either as single therapy (65.4%) (17 patients, 18 surgeries), dual therapy with gabapentin and amitriptyline (five patients), or triple therapy with gabapentin, amitriptyline, and methadone (four patients). The mean starting (maximum) doses of gabapentin, amitriptyline, and methadone (mg/kg/day) were 20.2 (43.8), 0.5 (0.7), and 0.3 (0.3), respectively. The incidence and duration of NP, duration of treatment, and NP-specific dose regimens were similar in the limb sparing and the amputation groups.

Conclusions: NP after definitive surgery for OS is frequently encountered, can persist for a significant time, and NP outcomes are similar in limb sparing and amputation groups.

Keywords: amputation; limb sparing; neuropathic pain; osteosarcoma.

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Conflict of interest statement

CONFLICT OF INTEREST

The authors declare that there is no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Flowchart: patients after definitive surgery for extremity OS
FIGURE 2
FIGURE 2
Duration of NP in patients receiving NP medications (N = 26 patients, 27 surgeries)
See this image and copyright information in PMC

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