Clinical Prediction Model and Tool for Assessing Risk of Persistent Pain After Breast Cancer Surgery

Meretoja, Tuomo J.; Andersen, Kenneth Geving; Bruce, Julie; Haasio, Lassi; Sipilä, Reetta; Scott, Norman; Ripatti, Samuli; Kehlet, Henrik; Kalso, Eija

doi:10.1200/jco.2016.70.3413

Cited by 88 publications

(112 citation statements)

References 29 publications

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“…Although efforts have been made to identify patients at risk for persistent pain after breast surgery, the relationship between persistent pain and chronic opioid use has not been delineated . Previous studies have shown that patient psychological characteristics (psychological “robustness” and tolerance of pain) can profoundly impact perception of pain and other symptoms as a consequence of breast surgery .…”

Section: Discussionmentioning

confidence: 99%

Surgeon perception versus reality: Opioid use after breast cancer surgery

Park

Kyrish

Terrell

et al. 2019

Journal of Surgical Oncology

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Background Few guidelines exist for an opioid prescription after breast surgical oncology (BSO) procedures. We sought to characterize opioid prescribing and use patterns by surgery type. Methods Patients (n = 332) undergoing BSO procedure were surveyed one week postoperatively for opioid use. The surgeons were surveyed about pain management preferences surgery type. CPT codes were collected for 2017 to calculate the amount of opioids used by surgery type relative to surgeon preference. Results Mean oral morphine equivalent (OME) preferred prescription for surgeons who did not tailor prescriptions by surgery type (n = 7, group A) was 177, whereas for those who did tailor (n = 10, group B) varied from 137 to 257 OME. There was a significant difference in opioid use by surgery type: 32 OME for segmental mastectomy (SM) ± sentinel lymph node dissection (SLND), 63 for SM + axillary lymph node dissection (ALND), 76 for total mastectomy (TM) ± SLND, 115 for TM + ALND (P < 0.001). Considering the type of surgeries performed group A prescribers would have 229190 unused OME and group B would have 230826 in 1 year. Conclusion Wide variation in opioid use by BSO procedure type was noted with substantial unused OME regardless ofprescribing preference. Evidence‐based guidelines are needed to tailor analgesic prescriptions according to the need.

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Section: Discussionmentioning

confidence: 99%

Surgeon perception versus reality: Opioid use after breast cancer surgery

Park

Kyrish

Terrell

et al. 2019

Journal of Surgical Oncology

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“…62 Using these predictive factors, validated risk-stratification tools have been developed to provide an individualised indication of risk, potentially enabling targeting of resources or early intervention. 63…”

Section: Risk Factors For Cpspmentioning

confidence: 99%

Pain in cancer survivors; filling in the gaps

Brown

Farquhar-Smith

2017

British Journal of Anaesthesia

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Cancer survivorship represents a growing clinical challenge for pain clinicians. The population of cancer survivors is rapidly expanding and many of these patients experience pain as a sequelae of their disease and its treatment. The features, pathophysiology and natural history of some painful conditions observed in cancer survivors, such as direct tumour effects, cancer induced bone pain (CIBP) or chronic post-surgical pain have received extensive exposure elsewhere in the literature. In this narrative review, we attempt to 'fill in the gaps' in the knowledge, by providing a succinct outline of a range of less well known pain states encountered in the cancer survivor population. These include neuropathies as a result of graft versus host disease (GVHD), novel chemotherapeutic agents and monoclonal antibodies (mAb), and radiation induced pain states. The increasing prevalence of visceral post-surgical pain and aromatase inhibitor-induced arthralgia (AIA) is also detailed. Additionally an overview of suggested approaches to the assessment of pain in cancer survivors is provided and potential treatment strategies, with a focus on novel approaches are discussed.

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“…persistent pain after breast cancer treatment (18)(19)(20). Therefore, the contribution of treatment-related variables, such as type of surgery and adjuvant treatment modalities (radiotherapy, chemotherapy, trastuzumab), and different types of hormone therapy to higher levels of central sensitization, has to be evaluated.…”

mentioning

confidence: 99%

Unraveling Self-Reported Signs of Central Sensitization in Breast Cancer Survivors with Upper Limb Pain: Prevalence Rate and Contributing Factors

et al. 2018

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Background: Hypersensitivity of the central nervous system to environmental and chemical stimuli is a clinical feature of central sensitization mechanisms that can be assessed with the central sensitization inventory (CSI). Objective: The aim was to determine prevalence rate of this feature and explore the treatment-, patient-, pain-, and psychosocial-related variables associated with the degree of self-reported signs of central sensitization, assessed with the CSI (0-100), in breast cancer survivors at long-term. Study Design: Cross-sectional study. Setting: University Hospitals, Leuven, Belgium. Methods: One hundred and forty-six women with persistent pain, more than one year after breast cancer surgery, were included. The following factors were analyzed by bivariable and multivariable analysis: 1) treatment-related variables (type of surgery, levels of lymph node dissected, radiotherapy, chemotherapy, hormone therapy, and trastuzumab); 2) patient’s related variables (age and body mass index); 3) pain-related variables (pain intensity, pain quality, primary hyperalgesia, and index of widespread pain); and 4) psychosocial variables (the degree of pain catastrophizing and vigilance and awareness to pain). The dependent variable was degree of central sensitization measured with the CSI. Additionally, a stepwise regression was performed. Results: Fifty-five (38%) patients reported signs of central sensitization measured with the CSI (i.e., > 40/100). From multivariable analysis, it appears that more severe pain quality and higher levels of pain catastrophizing contribute to a higher degree of central sensitization. The stepwise regression revealed that up to 24% of variance of the CSI can be explained by these factors. Limitations: A selection bias may be present since patients were all recruited from a larger cohort participating in clinical trials on the effectiveness of physical therapy after breast cancer treatment. Conclusion: Signs of central sensitization cannot be neglected in breast cancer survivors at long term. More severe pain quality and pain catastrophizing contribute to higher levels of central sensitization in this population. Key words

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Clinical Prediction Model and Tool for Assessing Risk of Persistent Pain After Breast Cancer Surgery

Cited by 88 publications

References 29 publications

Surgeon perception versus reality: Opioid use after breast cancer surgery

Surgeon perception versus reality: Opioid use after breast cancer surgery

Pain in cancer survivors; filling in the gaps

Unraveling Self-Reported Signs of Central Sensitization in Breast Cancer Survivors with Upper Limb Pain: Prevalence Rate and Contributing Factors

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