Clinical Pharmacology 168.734
August 2015

Assessment 2

In Women undergoing Mastectomy ± Auxiliary Node Dissection / Removal, how does the
Pre-emptive administration of Gabapentin compared to Venlafaxine affect the incidence of post mastectomy pain syndrome at a 6 month post-surgery review date?

Emma Burke
15086920
Elective and Acute General and Vascular Surgery (A4)
Hawkes Bay District Health Board
Pain Management Resource Nurse for A4
Goal to become Clinical Nurse Specialist in Pain Management

Post Mastectomy Pain Syndrome (PMPS) affects between 20-60% of women who had a mastectomy [1-14]. “Poorly managed pain can slow recovery, create burdens for patients & their families, & increase costs to the healthcare system”[13] & taxpayer. If this can be significantly reduced, it has to be better for the women, their families & society. Each year in NZ there are >2800 women diagnosed with Breast Cancer, with the number increasing each year [14]. “PMPS is defined as a chronic pain. It is considered a neuropathic condition which arises after surgery for breast cancer PMPS is different from other painful syndromes as it is typically localised to the anterior or lateral region of the thorax, auxiliary&/or medial upper arm, causing burning pain, shooting pain, pressure sensation or numbness”.[15-20]. This report analysed over 45 different journal articles that looked at the incidence of PMPS & treatment options [1,2,4-15,21-51]. The use of Gabapentin & Venlafaxine showed statistically significant data to warrant further consideration [1,2,8,11,1327,31,32,34,39,40,46,47,50,51] Gabapentin, initially used to treat seizure disorders[22,24,26] now it is commonly used to treat neuropathic pain [35,41] & has opioid sparing properties which makes it ideal in the postoperative setting39,52]. Venlafaxine, a serotonin