Characterization of Preoperative, Postsurgical, Acute and Chronic Pain in High Risk Breast Cancer Patients

Abstract

Background: Pain after breast cancer surgery remains largely unexplained and inconsistently quantified. This study aims to describe the perioperative pain patterns in patients with breast cancer, up to two years after surgery. Methods: This is a pre-planned sub-study of the Ketorolac in Breast Cancer (KBC) trial. The KBC trial was a multicentre, prospective, double-blind, placebo-controlled, randomised trial of a single dose of 30 mg of ketorolac just before breast cancer surgery, aiming to test its effect on recurrences. This sub-study focuses only on pain outcomes. From 2013 to 2015, 203 patients were randomised to ketorolac (n = 96) or placebo (n = 107). Structured questionnaires were delivered by telephone after one and two years, exploring the presence, location, permanence, and frequency of pain. Patients’ perceptions of pain were captured by an open-ended question, the responses to which were coded and classified using hierarchical clustering. Results: There was no difference in pain between the ketorolac and the placebo group. The reported incidence of permanent pain was 67% and 45% at one and two years, respectively. The largest category was musculoskeletal pain. Permanent pain was mainly described in patients with musculoskeletal pain. The description of pain changed in most patients during the second postoperative year, i.e., moved from one category to another (no pain, permanent, or non-permanent pain, but also, the localisation). This phenomenon includes patients without pain at one year. Conclusions: Pain is a complex phenomenon, but also a fragile and unstable endpoint. Pain after breast cancer surgery does not necessarily mean breast pain but also musculoskeletal and other pains. The permanence of pain and the pain phenotype can change over time.

Hypnosis Sedation Reduces the Duration of Different Side Effects of Cancer Treatments in Breast Cancer Patients Receiving Neoadjuvant Chemotherapy

“…These drugs are efficient to decrease acute postoperative pain but less efficient to attack long-term toxicities of cancer treatments such as musculoskeletal pain and polyneuropathy. In the study published by Forget, no difference was noted between the group receiving ketorolac and the placebo group, but only one shot of ketorolac was administered [25]. According to the results of our study, hypnosis sedation is able to reduce the inflammatory reaction related to the surgical procedure.…”

“…Not all included patients received schedules of chemotherapy with taxanes. In the study of Forget, polyneuropathy was measured one and two years after surgery [25]. The prevalence of PNP was respectively 22% and 10% of patients one and two years after surgery.…”

“…In a recent study published by Forget (pre-planned sub-study of the Ketorolac in Breast Cancer trial-KBC), the authors reported an incidence of permanent pain at one year comprised between 65 and 75% and incidence of persistent pain between 59 and 63% at two years [25]. The authors mentioned that the description and location of pain changed during the second postoperative year [25].…”

“…It is well recognized that shortened duration of POP is a very important parameter to avoid persistent pain after breast surgery. As mentioned in the study of Forget, the location of POP changes after one and two years and it sometimes becomes difficult to characterize pain [25]. Intrication with musculoskeletal pain is not infrequent [25].…”

“…As mentioned in the study of Forget, the location of POP changes after one and two years and it sometimes becomes difficult to characterize pain [25]. Intrication with musculoskeletal pain is not infrequent [25].…”