A significant proportion of patients undergoing thoracotomies will suffer from chronic pain. Surgeons and anaesthetists should be aware of this fact and they should look for effective means of preventing and treating this pain syndrome.

Chronic pain was more common after breast-conserving surgery than after radical surgery. Surgical complications and postoperative radiotherapy and chemotherapy increased the risk of chronic pain and other symptoms. Modifications in the treatment protocol and preclusion of postoperative complications may be necessary in order to minimize chronic treatment-related symptoms.

Summary This study assessed pain, neurological symptoms, oedema of the ipsilateral arm, anxiety and depression occurring in women treated surgically for breast cancer, the impact of these symptoms on daily life and how they evolved during the 1 year follow-up. Ninety-three consecutive patients with non-metastasised breast cancer who were treated during 1993 -94 were examined before surgery and after 1, 6 and 12 months. They were asked about pain, neurological symptoms and oedema in the breast scar region and/or ipsilateral arm. Sensory testing was performed, and gripping force and the circumference of the arm were measured. Anxiety and depression were evaluated. One year after surgery, 80% of the women had treatment-related symptoms in the breast scar region and virtually all patients had symptoms in the ipsilateral arm. The incidence of chronic post-treatment pain was higher after conservative surgery than after radical surgery (breast area: 33% vs 17%, NS; ipsilateral arm: 23% vs 13%, NS). Numbness occurred in 75% and oedema of the ipsilateral arm in over 30% of the patients after both radical and conservative surgery. Phantom sensations in the breast were reported by 25% of the patients. No difference in psychic morbidity was detected after the two types of surgery. Both the anxiety and depression scores were highest before surgery, decreasing with time, and were significantly correlated with preoperative stressful events.Keywords: breast cancer; breast surgery; chronic pain; quality of life Several recent studies (Rayter et al., 1990;Kuusk et al., 1992;Fisher et al., 1995) found no significant differences in the overall or disease-free survival between patients treated with either total mastectomy or breast-conserving surgery with breast radiation. However, follow-up studies indicate that some women suffer from various chronic treatment-related symptoms such as pain, sensory disturbances, oedema and muscle weakness, the reported incidence of which varies from 5 to 74% (Olsen et al., 1993;Thompson et al., 1995). Recently, Stevens et al. (1995) reported a 20% prevalence rate of the post-surgical pain syndrome in 95 women after breast surgery. The incidence of chronic pain did not differ statistically significantly after mastectomy compared with lumpectomy. In our recent retrospective study, in which 467 women completed a questionnaire on post-treatment symptoms 10-58 months after surgery, pain, paraesthesiae or strange sensations were reported by half of the patients. These chronic treatment-related symptoms were more common after breast resection (BCT) than after modified radical mastectomy (MRM) (Tasmuth et al., 1995). The incidence of pain in the operated breast area after both types of surgery and in the ipsilateral arm after MRM was higher if less time had elapsed since surgery. About 25% of the patients in this study reported chronic pain that affected their daily lives at least moderately.A few studies have examined the time course of various post-treatment symptoms following treatment of breast cancer...

Chronic post-sternotomy pain is an important complication that may have a significant impact on the patient's everyday life. Future studies will show whether minimising complications, improving postoperative care and starting early adequate pain management will reduce the incidence of this problem.

In our recent retrospective study on breast cancer patients, the intensity of the past postoperative pain was a primary factor in predisposing the development of chronic post-treatment pain. The present prospective study was designed to find out if the remembered intensity of postoperative pain (RIPP) after breast surgery was influenced by the development of chronic pain and if the RIPP had any correlation with the development of depression or anxiety. The patient's estimation of the severity of the RIPP was determined three times in the year after surgery. The state anxiety and depression and the presence of pain in the ipsilateral arm were assessed before the operation, and 1, 6 and 12 mos after surgery. Ninety-three consecutive female patients with breast cancer who were enrolled for surgical treatment were recruited to the study during 1993-1994. The patients were treated with modified radical mastectomy with axillary clearance (n = 53) or breast resection with axillary clearance (n = 40). The patients' records were checked for the consumption of analgesics within the first 48 h after surgery. The patients were analysed in three groups according to the presence or absence of preoperative or chronic post-treatment pain. There was a significant correlation between the RIPP and the consumption of both opioids and NSAIDs on the ward. The women who had chronic pain remembered having had more severe postoperative pain compared with those women who had no chronic pain. The RIPP increased with time in the chronic pain patients whereas it decreased in the patients who had no chronic pain. In all patients the preoperatively measured state anxiety and depression scores were higher than in healthy Finnish women. One year after surgery anxiety and depression had returned to normal levels except in the patients who had chronic pain. Their depression remained at a higher level during the first year after surgery. The results suggest that the amount of postoperative pain may play a role in the development of chronic pain. However, the development of chronic pain is connected to a tendency to overestimate previous pain and to higher levels of depression.