Prevention of post-mastectomy neuropathic pain with memantine: study protocol for a randomized controlled trial

International audienceBackground: N-methyl-D-aspartate receptor antagonists are potential therapies for neuropathic pain, and memantine has a good tolerance profile. A preclinical study recently reported that presurgery memantine may prevent neuropathic pain development and cognition dysfunction. Considering the high prevalence of breast cancer and of post-mastectomy neuropathic pain, a clinical trial is carried out to evaluate if memantine may prevent neuropathic pain development and maintain cognitive function and quality of life in cancer patients. Methods/Design: A randomized clinical trial (NCT01536314) includes 40 women with breast cancer undergoing mastectomy at the Oncology Hospital, Clermont-Ferrand, France. Memantine (5 to 20 mg/day; n = 20) or placebo (n = 20) is administered for 4 weeks starting 2 weeks before surgery. Intensity of pain, cognitive function, quality of life and of sleep, anxiety and depression are evaluated with questionnaires. The primary endpoint is pain intensity on a 0 to 10) numerical scale at 3 months post-mastectomy. Data analysis is performed using mixed models and the tests are two-sided, with a type I error set at α = 0.05. Discussion: The hypothesis of this translational approach is to confirm in patients the beneficial prophylactic effect of memantine observed in animals. Such a protective action of memantine against neuropathic pain and cognitive dysfunction would greatly improve the quality of life of cancer patients. Trial registration: ClinicalTrials.gov: NCT01536314 on 16 February 201

Regard sur le travail : quand les aides à domicile deviennent "auxiliaires de vie sociale". Pour agir sur leurs conditions de travail et sur leur santé

Aborder le métier des aides à domicile sous l'angle des "conditions concrètes du travail et de la santé au travail " est une piste encore peu explorée dans ce secteur professionnel. Leur travail est utile dans une société vieillissante mais il est méconnu. Il exige des compétences multiples. Les aides à domicile " tissent " au quotidien différentes activités auprès des personnes aidées (ménage, aide à la toilette, relation d'écoute et de soutien psychologique, etc.) et sont tiraillées entre plusieurs priorités car le temps est limité. Elles font un travail pénible physiquement, s'adaptent à chaque situation, à chaque famille et accompagnent les personnes en fin de vie. Aussi, les aides à domicile payent un lourd tribut aux problèmes de santé au travail. La prévention des risques constitue un enjeu dans ces professions. Comprendre le travail concret des aides à domicile constitue la condition indispensable pour que l'ensemble des "acteurs" du maintien à domicile (aides à domicile, encadrement, financeurs, personnes aidées, etc.) mettent en commun des solutions possibles. Il y a notamment un gisement d'améliorations des conditions de travail des aides à domicile dans la professionnalisation des structures elles-mêmes. Cependant se pose la question cruciale des moyens mis à disposition de celles-ci, à mettre en relation avec la façon dont les pouvoirs publics comprennent et évaluent le travail de ces professionnelles. Des expériences au Québec et en Belgique sont évoquées. Ce document a pour objectif de servir de support à des échanges et à des propositions d'améliorations et au développement de postures citoyennes à la hauteur des défis que l'action des aides à domicile relève au quotidien

Predicting Pain Trajectories in the One Year Following Breast Cancer Diagnosis—An Observational Study

International audienceThe impact of psychosocial vulnerability on pain in the year following breast cancer diagnosis has been little studied. To identify a score of psychosocial vulnerability (cognitive, emotional, quality of life and precariousness parameters) as a predictor of a pain trajectory, we conducted an observational prospective study and included women with newly diagnosed breast cancer. One year follow-up with 3 visits (day of breast cancer diagnosis; 6 and 12 months) aimed to identify distinct pain-time trajectories. Baseline psychosocial vulnerability was characterized by z-score transformation, a higher score representing a more vulnerable patient. A total of 89 patients were included (59.3 ± 10.7 years). Two trajectories of pain were identified-"Transient Pain trajectory" (TP) (39/89 patients) and "Persistent Pain trajectory" (PP) (50/89). A significant difference of pain over time between trajectories (PP vs. TP at 6 months: 2.23 ± 0.23 vs. 0.27 ± 0.09, p < 0.001) was observed. Psychosocial vulnerability showed a large effect size (d, -0.82; 95% CI, -1.25 to -0.38; p < 0.001) and a higher score in "Persistent pain trajectory" (PP vs. TP: 0.12 ± 0.36 vs. -0.14 ± 0.26, p < 0.001). A predictive vulnerability marker of pain development is proposed and could be used at cancer diagnosis to orientate the care pathway of patients experiencing breast cancer

Résilience, archétypes narratifs et identité narrative dans le récit de vie de jeunes adultes

Dix-huit récits de vie ont été analysés afin de vérifier si les thèmes de l’identité narrative et les archétypes narratifs permettent de les contraster selon la présence évidente ou non de la résilience chez les jeunes adultes. Les thèmes de l’identité narrative sont des repères utiles pour cerner les trajectoires émergeant du récit des jeunes adultes. Compte tenu de leur proximité théorique, nous examinons si les concepts se recoupent et s’alimentent l’un l’autre dans les récits. Notons que chaque récit, bien qu’il porte sur l’ensemble de l’histoire de l’individu, est raconté à un moment précis, où différents enjeux peuvent nuire momentanément à l’expression de la résilience.This exploratory study analyzes 18 emerging adults’ narrative to verify whether themes from narrative identity theory (redemption, agency, communion, etc.) and narrative story arcs were helpful in contrasting the presence or the absence of resilience in life-stories. Results indicate that both narrative arcs and narrative identity themes were useful concepts to delineate resilient trajectories from those where resiliency is not obvious. Given their conceptual proximity, we discussed how resiliency, narrative identity and narrative arcs intersect and feed one another. Practical use of the narratives to generate resilience are highlighted. Authors are mindful of the fact that narratives, even though they recount the whole life-story of the participant, are told at a specific time where various issues may hinder the expression of resiliency

Memantine before Mastectomy Prevents Post-Surgery Pain: A Randomized, Blinded Clinical Trial in Surgical Patients

<div><p>Background</p><p>Neuropathic pain following surgical treatment for breast cancer with or without chemotherapy is a clinical burden and patients frequently report cognitive, emotional and quality of life impairment. A preclinical study recently showed that memantine administered before surgery may prevent neuropathic pain development and cognitive dysfunction. With a translational approach, a clinical trial has been carried out to evaluate whether memantine administered before and after mastectomy could prevent the development of neuropathic pain, the impairment of cognition and quality of life.</p><p>Method</p><p>A randomized, pilot clinical trial included 40 women undergoing mastectomy in the Oncology Department, University Hospital, Clermont-Ferrand, France. Memantine (5 to 20 mg/day; n = 20) or placebo (n = 20) was administered for four weeks starting two weeks before surgery. The primary endpoint was pain intensity measured on a (0–10) numerical rating scale at three months post-mastectomy.</p><p>Results</p><p>Data analyses were performed using mixed models and the tests were two-sided, with a type I error set at α = 0.05. Compared with placebo, patients receiving memantine showed at three months a significant difference in post-mastectomy pain intensity, less rescue analgesia and a better emotional state. An improvement of pain symptoms induced by cancer chemotherapy was also reported.</p><p>Conclusions</p><p>This study shows for the first time the beneficial effect of memantine to prevent post-mastectomy pain development and to diminish chemotherapy-induced pain symptoms. The lesser analgesic consumption and better well-being of patients for at least six months after treatment suggests that memantine could be an interesting therapeutic option to diminish the burden of breast cancer therapy.</p><p>Trial Registration</p><p>Clinicaltrials.gov <a href="http://www.clinicaltrials.gov/ct2/show/NCT01536314" target="_blank">NCT01536314</a></p></div

Effect of memantine on pain in patients who had chemotherapy.

<p>(A) ΔNRS score is the pain intensity difference between Month 3 or Month 6 and baseline. It is significant in the subgroup of chemotherapy which received memantine (n = 11) compared with placebo (n = 10) at Month 3 (p = 0.01) and at Month 6 (p = 0.01). (B) Neuropathic pain (ΔDN4 score) is the neuropathic pain score difference between Month 3 or Month 6 and baseline. Neuropathic pain score in four questions was significantly diminished in the memantine group at Month 3 (***p = 0.001) and at Month 6 (p = 0.009). (C) Number of patients n (%) who replied positively to question 2 (Q2) of DN4 (dysesthesias and paresthesias). In the memantine group, a decrease of 55% of dysesthesias and paresthesias was reported at Month 3 compared with the day of inclusion (Baseline) (p = 0.01).</p

Effect of memantine on quality of sleep with Leeds sleep questionnaire.

<p>Effect of memantine on quality of sleep with Leeds sleep questionnaire.</p

Effect of memantine on cognition.

<p>Effect of memantine on cognition.</p

Demographics and clinical characteristics.

<p>Demographics and clinical characteristics.</p

Effect of memantine on analgesics consumption.

<p>Number of patients n (%) being prescribed neuropathic pain analgesics. A significant increase in analgesics (especially antiepileptics) prescriptions was reported in the placebo group (n = 20) compared with the memantine group (n = 20) at Month 3 and maintained at Month 6 (p = 0.040).Over all time different was significant (p = 0.041).</p