To investigate the prevalence and risk factors associated with chronic pain and other symptoms related to breast cancer 6 months after surgery.
Methods:
In an observational study of 261 female breast cancer survivors treated between January 2017 and January 2018, patients were asked about their pain symptoms using a questionnaire that utilized the Numeric Rating Score (NRS) and the Douleur Neuropathique Score (DN4) for neuropathic pain; it also addressed phantom sensations and functional disorders on the ipsilateral shoulder. A total of 218 women completed the survey.
Results:
A total of 105 patients (48.17%) reported chronic pain. Of these, 64% rated the pain with an NRS of 1–3 and 35% with an NRS >3. Neuropathic pain was reported in 65% of the sample, phantom sensations in 12%, disorders of shoulder function in 16%, and web syndrome in 2%. Multivariable analyses showed that chronic pain (odds ratio [OR], 2.55; 95% confidence interval [CI], 1.094–5.942; p < 0.05) and neuropathic pain (OR, 2.988; 95% CI, 1.366–6.537; p < 0.05) were positively associated with surgical adverse events; phantom sensations were statistically associated with the weight of removed breast tissue (OR, 1.003; 95% CI, 1.001–1.005; p < 0.05).
Conclusions:
Our study highlights the need to employ specific tools capable of detecting different kinds of chronic pain after breast cancer surgery to improve pain prevention and treatment. Surgical complications and the weight of removed breast tissue emerged as 2 of the risk factors for chronic and neuropathic pain development in breast cancer survivors.
KennethGAHenrikK. Persistent pain after breast cancer treatment: a critical review of risk factors and strategies for prevention. Pain2011; 12: 725–746.
2.
HowladerNNooneAMKrapchoM, et al. SEER Cancer Statistics Review, 1975–2014. Bethesda, MD: National Cancer Institute; 2017.
3.
EbaughDSpinelliBSchmitzKH. Shoulder impairments and their association with symptomatic rotator cuff disease in breast cancer survivors. Med Hypoth2011; 77: 481–487.
4.
KatzJPoleshuckELAndrusCH. Risk factors for acute pain and its persistence following breast cancer surgery. Pain2005; 119: 16–25.
CarpenterJSAndrykowskiMASloanP, et al. Postmas-tectomy/postlumpectomy pain in breast cancer survivors. J Clin Epidemiol1998; 51: 1285–1292.
8.
DualéCOuchchaneLSchoefflerP, et al. Neuropathic aspects of persistent postsurgical pain: a French multicenter survey with a 6-month prospective follow-up. Pain2014; 15: 21–24.
9.
HaroutiunianSNikolajsenLFinnerupNB, et al. The neuropathic component in persistent postsurgical pain: a systematic literature review. Pain2013; 154: 95–102.
10.
FletcherDStamerUMPogatzki-ZahnE, et al. Chronic postsurgical pain in Europe: an observational study. Eur J Anaesthesiol2015; 32: 725–734.
11.
WernerMUMjoboHNNielsenPR, et al. Prediction of postoperative pain: a systematic review of predictive experimental pain studies. Anesthesiology2010; 112: 1494–1502.
12.
Lavand’hommePPogatzki-ZahnE. Chronic postsurgical pain: definition, impact, and prevention: International Association for the Study of Pain, fact sheet no. 4, https://www.iasp-pain.org/globalyear (2017).
13.
PoleshuckELKatzJAndrusCH, et al. Risk factor for chronic pain following breast cancer surgery: a prospective study. J Pain2006; 7: 626–634.
14.
TreedeRDRiefWBarkeA, et al. A classification of chronic pain for ICD-11. Pain2015; 156: 1003–1007.
15.
BelferISchreiberKLShafferJR, et al. Persistent postmastectomy pain in breast cancer survivors: analysis of clinical, demographic, and psychosocial factors. Pain2013; 14: 1185–1195.
16.
PiracciniEBiondiGCorsoRM, et al. The use of rhomboid intercostal block, parasternal block and erector spinae plane block for breast surgery. J Clin Anesth2020; 59: 10.
17.
KimSYSongJWParkB, et al. Pregabalin reduces post-operative pain after mastectomy: a double-blind, randomized, placebo-controlled study. Acta Anaesthesiol Scand2011; 55: 290–296.
18.
AndersenKGDuriaudHMJensenHE, et al. Predictive factors for the development of persistent pain after breast cancer surgery. Pain2015; 156: 2413–2422.
19.
BredalISSmebyNAOttesenS, et al. Chronic pain in breast cancer survivors: comparison of psychosocial, surgical, and medical characteristics between survivors with and without pain. Pain2014; 48: 855–856.
20.
SteegersMAWoltersBEversAW, et al. Effect of axillary lymph node dissection on prevalence and intensity of chronic and phantom pain after breast cancer surgery. Pain2008; 9: 813–822.
21.
WalthoDRockwellG. Post–breast surgery pain syndrome: establishing a consensus for the definition of post-mastectomy pain syndrome to provide a standardized clinical and research approach-a review of the literature and discussion. Can J Surg2016; 59: 342–350.
22.
AndersenKGJensenMBKehletH, et al. Persistent pain, sensory disturbances and functional impairment after adjuvant chemotherapy for breast cancer: cyclophosphamide, epirubicin and fluorouracil compared with docetaxel + epirubicin and cyclophosphamide. Acta Oncol2012; 51: 1036–1044.
23.
PaduaLBrianiCTruiniA, et al. Consistence and discrepancy of neuropathic pain screening tools DN4 and ID-Pain. Neurol Sci2013; 34: 373–377.
24.
GartnerRJensenMBNielsenJ, et al. Prevalence of and factors associated with persistent pain following breast cancer surgery. JAMA2009; 302: 1985–1992.
25.
JungBFAhrendtGMOaklanderAL, et al. Neuropathic pain following breast cancer surgery: proposed classification and research update. Pain2003; 104: 1–13.
26.
De GroefAMeeusMDe VriezeT, et al. Pain characteristics as important contributing factors to upper limb dysfunctions in breast cancer survivors at long term. Musculoskelet Sci Pract2017; 29: 52–59.
27.
SagenAKaaresenRSandvikL, et al. Upper limb physical function and adverse effects after breast cancer surgery: a prospective 2.5-year follow-up study and preoperative measures. Arch Phys Med Rehabil2014; 95: 875–881.
28.
StubbfieldMDKeoleN. Upper body pain and functional disorders in patients with breast cancer. Phys Med Rehabil2014; 6: 170–183.
29.
HladiukMHuchcroftSTempleW, et al. Arm function after axillary dissection for breast cancer: a pilot study to provide parameter estimates. J Surg Oncol1992; 50: 47–52.
30.
ColemanREBoltenWWLansdownM, et al. Aromatase inhibitor-induced arthralgia: clinical experience and treatment recommendations. Cancer Treat Rev2008; 34: 275–282.
31.
WindebankAJGrisoldW. Chemotherapy-induced neuropathy. J Peripher Nerv Syst2008; 13: 27–46.
32.
DionigiR. Chirurgia: Basi Teoriche e Chirurgia Generale. Trento: Masson; 2015.
33.
FabroEANBergmannASilvaBA, et al. Post-mastectomy pain syndrome: incidence and risks. Breast2012; 21: 321–332.
PacificiRPalmiIMastrobattistaL. Il fumo di tabacco degli Italiani. DOXA-ISS Tabaccologia2017; 2.
36.
FuzierRPuelFIzardP, et al. Prospective cohort study assessing chronic pain in patients following minor surgery for breast cancer. J Anesth2017; 31: 246–254.
37.
LeysenLAdriaenssensNNijsJ, et al. Chronic pain in breast cancer survivors: nociceptive, neuropathic, or central sensitization pain?Pain Pract2019; 19: 183–195.
38.
ScaffidiMVulpianiMCVetranoM, et al. Early rehabilitation reduces the onset of complications in the upper limb following breast cancer surgery. Eur J Phys Rehabil Med2012; 48: 601–611.
39.
MoskovitzAH. Axillary web syndrome after axillary dissection. Am J Surg2001; 181: 434–439.
40.
National Institute for Health and Care Excellence. Clinical guideline CG173/2017: Neuropathic pain: pharmacological management: the pharmacological management of neuropathic pain in adults in non-specialist settings (last updated July2019), http://guidance.nice.org.uk/CG173 (2013).
