Pain, numbness, or both? Distinguishing the longitudinal course and predictors of positive, painful neuropathic features vs numbness after breast cancer surgery

Abstract

Introduction: Both positive (burning, stabbing, and allodynia) and negative (numbness) neuropathic symptoms may arise after surgery but likely contribute differently to patients' postoperative pain experience. Numbness has been identified as divergent from positive neuropathic symptoms and therefore excluded from some neuropathic assessment tools (Neuropathic Pain Scale for PostSurgical patients [NeuPPS]). Objectives: In this prospective longitudinal study of patients undergoing breast surgery, we aimed to delineate the time course of numbness and its coincidence with NeuPPS and to contrast the association of surgical, psychosocial, and psychophysical predictors with the development of negative vs positive neuropathic symptoms. Methods: Patients reported surgical area sensory disturbances at 2 weeks and 3, 6, and 12 months postoperatively. Association of baseline demographic, surgical, psychosocial, and psychophysical factors with NeuPPS and numbness across time was investigated using generalized estimating equation linear and logistic regression. Results: Numbness was consistently reported by 65% of patients; positive neuropathic symptoms were less common, often decreasing over time. Neuropathic Pain scale for PostSurgical patients and numbness co-occurred in half of patients and were both associated with greater clinical pain severity and impact, younger age, axillary surgery, and psychosocial factors. More extensive surgery and chemotherapy were only associated with numbness. Conversely, other chronic pain, lower physical activity, perioperative opioid use, negative affect, and lower baseline pressure pain threshold and tolerance were only associated with NeuPPS. Patients reporting numbness alone did not endorse substantial clinical pain. Conclusions: Differentiation of predictors, prevalence, and time course of numbness vs NeuPPS in breast surgical patients revealed important distinctions, suggesting that their independent assessment is worthwhile in future studies of postsurgical pain.

Symptom clusters and their predictors in patients with lung cancer and treated with programmed cell death protein 1 immunotherapy

“… 33 The etiology of this cluster is not entirely clear, but it may be related to inflammation changes and damage to peripheral neurons caused by chemotherapy drugs. 34 Furthermore, chemotherapy is not the only cause for these symptoms –– palliative radiation therapy, 35 surgery, 36 and even PD-1 immunotherapy 23 , 37 have also been found to be related to pain and numbness. The mechanisms leading to this symptom cluster need further exploration.…”

Characterizing mechanism-based pain phenotypes in patients with chronic pancreatitis: a cross-sectional analysis of the PROspective Evaluation of Chronic Pancreatitis for EpidEmiologic and Translational StuDies

“…Future studies should add the psychophysical measures of somatization and PPT to determine whether, in combination with anxiety and depression, they are sufficient to categorize patients with CP in a similar manner as shown for TMD and breast mastectomy pain. 3 , 12 , 13 …”

“…Future studies should add the psychophysical measures of somatization and PPT to determine whether, in combination with anxiety and depression, they are sufficient to categorize patients with CP in a similar manner as shown for TMD and breast mastectomy pain. 3,12,13 The identification of specific pain mechanisms is key for identifying the intervention most likely to provide relief. Pharmacologic (prescribed or nonprescribed) interventions function through different mechanisms of action and are therefore predicted to have differing efficacy depending on the underlying mechanism driving an individual patient's pain.…”

Cryoneurolysis: Interest and Caution

“…5 These studies suggest that numbness diverges from other, positive/ painful neuropathic symptoms (burning, shooting, among others), underscoring careful longitudinal assessment of individual symptoms. 6 Potential for such postinjury chronic neuropathic pain remains the loudest note of caution when considering widespread application of cryoneurolysis. Neuropathic pain is produced so reliably after cryoneurolysis that it has been used as a model of chronic pain development in rodents since the 1990s.…”

“…5 These studies suggest that numbness diverges from other, positive/painful neuropathic symptoms (burning, shooting, among others), underscoring careful longitudinal assessment of individual symptoms. 6…”