Incidence and etiology of postoperative chronic pain after breast surgery

Abstract

Objective: The primary aim of this study was to determine the incidence of chronic postoperative pain after the types of breast surgery. The secondary aim was to examine the factors associated with chronic postoperative pain. Methods: The prospective study included 240 female patients. Data were collected on: visual analogue scale (VAS) pain scores in the Post Anesthesia Care Unit (PACU) at 1st month and at 3rd-6th months postoperatively; and age, BMI, preoperative pain, radiotherapy, chemotherapy, postoperative acute pain, length of hospital stay were the measures taken into account. Results: Chronic postoperative pain was experienced by 39.2% of patients at 3 rd month and 18.3% of patients at 6 th month. Chronic pain was detected in 41.8% of patients who had severe acute postoperative pain. BMI, age, preoperative and severe acute postoperative pain, the type of surgery, the length of hospital stay, development of complications, chemotherapy and radiotherapy treatment have been shown to be the risk factors in chronic postoperative pain after breast surgery. The incidence of postmastectomy pain syndrome (PMPS) was 29.5% in mastectomy cases, and 64% in those having mastectomy and axillary dissection. Conclusion: As they are considered as complication of surgery according to some authors, chronic postoperative pain and post-mastectomy pain syndrome are commonly discussed and studied clinical problems in recent years. More comprehensive studies about its etiology, risk factors and pathogenesis to prevent or treat the chronic postoperative pain and post-mastectomy pain syndrome are warranted as it both reduces life comfort and causes workforce loss following surgery.Key words: Postoperative pain, breast surgery, chronic pain ÖZ Amaç: Bu çalışmanın birincil amacı, farklı tiplerde meme cerrahisi sonrası kronik postoperatif ağrı insidansını, ikincil amacı, kronik postoperatif ağrı ile ilişkili faktörleri araştırmaktır. Yöntemler: Bu prospektif çalışma 240 kadın hasta ile yürütüldü. Hastaların postoperatif derlenme ünitesinde (PACU), postoperatif 1., 3. ve 6. aylarda VAS ağrı skorları, yaş, BMI, preoperatif ağrı, radyoterapi, kemoterapi, postoperatif akut ağrı ve hastanede kalış süresi verileri toplandı. Bulgular: Hastaların %39,2'si 3. ayda ve %18,3'ü ise postoperatif 6. ayda kronik postoperatif ağrı deneyimi yaşamıştır. Ciddi postoperatif ağrı çeken hastaların %41,8'inde kronik ağrı tespit edildi. BMI, yaş, preoperatif ve ciddi akut postoperatif ağrı, cerrahi tipi, hastanede kalış süresi, komplikasyon gelişmesi, kemoterapi ve radyoterapi tedavisi meme cerrahisi sonrasında kronik postoperatif ağrı gelişimi için risk faktörü olarak belirlendi. Mastektomi yapılan hastalarda postmastektomi ağrı sendromu (PMPS) %29,5 oranında görülürken, aksiller diseksiyonla birlikte mastektomi yapılanlarda bu oran %64 olarak saptandı. Tartışma ve Sonuç: Kimi otörler tarafından cerrahinin bir komplikasyonu olarak görülen kronik postoperatif ağrı ve postmastektomi sendromu son yıllarda sıkça tartışılmış ve çalışılmış klinik sorunla...

Analysis of the Incidence and Predictive Factors of Chronic Postoperative Pain in Adult Population

“…Contrary to all of these literature data, in our series age also plays a major role in the development of CPOP, and as age increases, the probability of chronic pain also increases. Sipila et al (12) and Turan et al (8) had similar results, namely they found a significant linear correlation between CPOP and age. Discrepancies between studies may depend on the type end extent of the operations, genetic characteristics and age of the populations, and socio-cultural differences that affect the expectations of the patients.…”

“…Most patients who experienced pain during the follow-up period were diagnosed with CPOP at the end of the second month (67 of 46; 68.7%). In our sample, we observed that the incidence of CPOP in Turkey was 14.8% when all types of (8) reported a pain incidence of 39.2% in 240 patients 3 months after breast surgery. In our study where patients with fairly even gender distribution underwent various types of surgery, the incidence of chronic pain was far lower (15%) than reported by Turan et al for their study group .…”

“…Studies that have evaluated the incidence of BMI and CPOP have reported a positive correlation between them, (8,12,14) which has been attributed to difficulties encountered during the surgical procedures performed in obese patients. Recently, it has been reported that some obese patients display hypoalgesia to noxious electrical stimuli (15) .…”

Postmastectomy Pain Syndrome: A Retrospective Cohort Study About The Relationship of Histopathological Type and Comorbidities

“…It is known that pathological types of breast tumor show different tissue invasion characteristics. [15,16] It is stated that metaplastic cancers are more aggressive compared to other types.…”