Pain at 12 Months After Surgery for Breast Cancer

Abstract

Persistent pain following breast cancer treatments remains a significant clinical problem despite improved treatment strategies. 1 Data on factors associated with persistent pain are needed to develop prevention and treatment strategies and to improve the quality of life for breast cancer patients. This prospective study examined the prevalence and severity of and the factors associated with chronic pain after breast cancer surgery and adjuvant treatments. Methods | Consecutive patients younger than 75 years with unilateral nonmetastasized breast cancer treated at the Helsinki University Central Hospital in 2006-2010 with either breastconserving surgery or mastectomy with axillary surgery were eligible. Patients receiving neoadjuvant treatment or immediate or delayed breast reconstruction or who had no breast cancer in the final histology were excluded. All women gave informed written consent. The ethics committee of the Helsinki University Central Hospital approved the study. Preoperatively, medical history, demographic data, Beck Depression Inventory, 2 and Spielberger State-Trait Anxiety Inventory 3 were obtained. Preoperative pain in the operative area (breast, axilla, arm) during the previous week was assessed with a numerical rating scale of 0 to 10 (0 = no pain; 1-3 = mild; 4-6 = moderate; ≥7 = severe). 4 Perioperative analgesia was standardized. All patients received acetaminophen and patient-controlled analgesia with intravenous oxycodone. Postoperatively, data were acquired on tumor and lymph node characteristics, complications of surgery, reoperations, and the prognostic risk category. 5 Adjuvant treatments were given according to international guidelines. 5 A questionnaire was sent to patients 12 months after surgery, with identical assessments of presence and intensity of pain. A bivariable analysis was conducted to determine factors related to pain at 12 months after surgery. The worst pain in any area was used for statistical analysis, in which pain was considered an ordinal variable. Variables with P < .10 in bivariable analyses were entered into an ordinal logistic regression analysis. All statistical tests were 2-sided with P < .05 considered statistically significant. SPSS Statistics version 20 (SPSS Inc) software was used.

Predictors of persistent pain after breast cancer surgery: a systematic review and meta-analysis of observational studies

“…26,35 Whether or not we incorporated missing data for nonsignificant predictors or converted categorical data for age and BMI to continuous data (Appendix 13, available at www.cmaj.ca/lookup/suppl/ doi:10.1503/cmaj.151276/-/DC1) did not appreciably influence the results. 42 Wilson et al, 2013 49 Mejdahl et al, 2013 26 Johansen et al, 2014 52 Lundstedt et al, 2012 41 De Oliveira et al, 2014 37 Steegers et al, 2008 44 Meretoja et al, 2014 58 Yang et al, 2010 51 Tasmuth et al, 1997 46 Shahbazi et al, 2015 60 Husen et al, 2006 40 Bell et al, 2014 59 Swenson et al …”

“…36,39,43,50,53,55,56 However, the results from these studies were consistent with the results from studies amenable to pooling. We used the IASP criteria for the definition of persistent pain in this review; however, 14 of the included studies did not report whether their assessment of persistent postsurgical pain excluded other causes of pain; 26,[33][34][35][36]43,45,47,48,50,51,54,56,58 as such, they may have overestimated the prevalence of persistent pain.…”

Preoperative Distress Predicts Persistent Pain After Breast Cancer Treatment: A Prospective Cohort Study

“…12 Several studies have indicated that psychological comorbidity is a risk factor for PPBCT, 1,13 with recent prospective studies indicating a correlation between preoperative psychological symptoms and PPBCT. 3,4,14,15 A prevalence of preoperative depression of 37% and anxiety of 70% has been reported among patients with breast cancer, 16 whereas the prevalence of severe psychological distress has been reported to be around 40%. [17][18][19] Longitudinal studies suggest a reciprocal relationship between depression and pain, 20,21 in that depression may lead to pain and vice versa.…”

A Recommendation in Pain Management After Breast Surgery: Hand Massage

“…13 Ameliyat öncesi ağrı ve ameliyat sonrası akut ağrı, ameliyat sonrası uzun dönemde gelişebilen kronik ağrı sendromlarında önemli risk faktörleri olarak tanımlanmaktadır. Ayrıca, ameliyat sonrası akut ağrının azaltılması sonucu, ameliyat sonrası kronik ağrı gelişme riskinin azaltılabileceği düşü-nülmektedir.…”

“…Ayrıca, ameliyat sonrası akut ağrının azaltılması sonucu, ameliyat sonrası kronik ağrı gelişme riskinin azaltılabileceği düşü-nülmektedir. [12][13][14][15][16][17] Bu nedenle akut ağrı yönetimi; bireyin cerrahi sonrası iyileşme süresinin kısaltılması, tedavi maliyetinin azaltılması, kronik ağrı oluşumunun önlen-mesi ve yaşam kalitesinin artırılması açısından önemlidir. Ağrı yönetiminde farmakolojik ajanlar ile birlikte gevşeme egzersizleri, sıcak-soğuk uygulama, aromaterapi, akapunktur, refleksoloji, masaj gibi nonfarmakolojik uygulamaların meme cerrahisi sonrası ağrı yönetiminde kullanılması önerilmek-tedir.…”