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

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.

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.

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.

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.

Pediatric blood & cancer. 2016 Aug 30 [Epub]

Doralina L Anghelescu, Brenda D Steen, Huiyun Wu, Jianrong Wu, Najat C Daw, Bhaskar N Rao, Michael D Neel, Fariba Navid

Pain Management Service, Division of Anesthesiology, Department of Pediatric Medicine, St Jude Children's Research Hospital, Memphis, Tennessee., Department of Anesthesiology, St Jude Children's Research Hospital, Memphis, Tennessee., Department of Biostatistics, St Jude Children's Research Hospital, Memphis, Tennessee., Division of Pediatrics, MD Anderson Cancer Center, Houston, Texas., Department of Surgery, St Jude Children's Research Hospital, Memphis, Tennessee., St. Jude Children's Research Hospital, Memphis, Tennessee., Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee.