Background
Persistent post-surgical pain (PPSP) in cancer survivors represents an increasing unmet need. It contributes to depression, anxiety and impacts on quality of life. There is limited understanding of the role of neuropathic pain mechanisms in PPSP. We performed a descriptive analysis of PPSP in breast cancer surgery at the Royal Marsden Hospital (RMH) who have received treatment with anti-neuropathic agents compared to non-antineuropathic agents.


Method
Patients who attended RMH Pain Clinics from January 2016 to December 2018 who consented to providing data through a bespoke tablet interface (Research Ethics Committee approved) were included.  PPSP post-breast cancer surgery patients were divided into two treatment groups; anti-neuropathics (pregabalin, gabapentin, duloxetine or amitriptyline plus other analgesics) or non-anti-neuropathic group (other analgesics; e.g. simple analgesics, opioids and/or topical agents). Average change in outcome measures Brief Pain Inventory (Symptom severity; SS and Interference severity; IS) and Hospital Anxiety and Depression Score; HADS before and after treatment were analyzed. Patient Satisfaction Scores were also analyzed.

Results
Fourteen patients were included in the anti-neuropathic group and seven in non anti-neuropathic group. The poor response rate of filling repeat attendance questionnaires account for the small number. The mean DN4 in the anti-neuropathic group is 5.0 while in the non anti-neuropathic group is 3.9. There is greater change in all outcome measures; IS (0.9), SS (0.6) and HADS (3.2) in the non-anti-neuropathic group compared to the anti-neuropathic group.

Conclusion
In the breast PPSP group, greater improvement were observed in SS, IS, HAD in the non-anti-neuropathic group compared to the anti-neuropathic group. Overall, despite the relatively small changes, patient satisfaction scores in both groups were high (90% and 77% in anti-neuropathic and non-anti-neuropathic group respectively).

COMPARING PERSISTENT POST-SURGICAL PAIN POST BREAST CANCER SURGERY AND THEIR RESPONSE TO ANTI-NEUROPATHIC AGENTS IN A SPECIALIST CANCER CENTRE