Persistent pain and sensory disturbances after treatment for breast cancer: six year nationwide follow-up study

Abstract

Objective To examine the development of persistent pain after treatment for breast cancer and to examine risk factors associated with continuing pain.Design Repeated cross sectional study in a previously examined nationwide cohort. All eligible women who underwent surgery for primary breast cancer in Denmark in 2005 and 2006 and were examined in 2008 were surveyed again with the same questionnaire. Setting Surgical centres in Denmark.Main outcome measures Prevalence, location, and severity of persistent pain after treatment for breast cancer in well defined treatment groups and changes in pain reporting and sensory disturbances from 2008 to 2012.Participants In 2012, 2828 women were eligible in our database, and 108 were excluded. Exclusion criteria were death; new, recurrent, or other cancer; reconstructive breast surgery; and emigration.Results 2411 (89%) women returned the questionnaire. Prevalence of persistent pain after treatment for breast cancer ranged from 22% to 53% depending on treatment. In 2012, 903 (37%) women reported such pain, a fall from 45% in 2008. Of these, 378 (16%) reported pain of ≥4 on a numerical rating scale (scale 0-10), a fall from 19%. Among women reporting pain in 2008, 36% no longer reported it in 2012. In contrast, 15% of the women who did not report pain in 2008 reported it in 2012. Risk factors for having pain were axillary lymph node dissection rather than sentinel lymph node biopsy (odds ratio 2.04, 95% confidence interval 1.60 to 2.61; P<0.001) and age ≤49 (1.78, 1.25 to 2.54; P<0.001). No particular method of treatment or age was associated with an increase in pain from 2008 to 2012.Conclusions Persistent pain after treatment for breast cancer remains an important problem five to seven years later. The problem is not static as it can either progress or regress with time.Trial registration Clinicaltrials.gov NCT No 01543711.

Reconstrução mamária imediata versus não reconstrução pós-mastectomia: estudo sobre qualidade de vida, dor e funcionalidade

“…The presence of pain in this study had higher frequency than in the studies found in the literature, for which rates ranged from 22% to 55% [20][21][22][23] . The findings of this research reveal the high prevalence of chronic pain, but there was no statistically significant difference between the groups.…”

“…As for the intensity of the pain, in the comparison between groups, there was no difference for any of the locations assessed, with the average pain intensity being low, except for the arm. For this last one, the average pain intensity was considered moderate 22 in both groups. This fact does not allow us to indicate a cause and effect relationship, because this is a cross-sectional study 24 and variables related to the surgery, such as nerve damage, were not controlled 25 .…”

Incidence and etiology of postoperative chronic pain after breast surgery

“…As chronic pain may be severe in 2-10% of these patients, chronic postoperative pain represents a major, mostly undiagnosed clinical issue (1,2) . Many studies reported that development of chronic pain after breast surgery is the most common problem with an incidence of 25-60% depending on the definition of incidence, measurement and treatment methods (3) . After ruling out other causes of pain such as recurrent painful episodes, chronic postoperative pain is defined as having pain related to surgical site over 3 months following surgery (3) .…”

“…Many studies reported that development of chronic pain after breast surgery is the most common problem with an incidence of 25-60% depending on the definition of incidence, measurement and treatment methods (3) . After ruling out other causes of pain such as recurrent painful episodes, chronic postoperative pain is defined as having pain related to surgical site over 3 months following surgery (3) . Chronic postoperative pain has a negative effect on the quality of life and creates important economic consequences for health system.…”

Correlação da dor e qualidade de vida de mulheres pós-tratamento cirúrgico de câncer de mama

“…O quadro álgico pode ocorrer em qualquer fase da doença, na maioria das vezes, decorrente de complicações do pós--operatório, radioterapia ou quimioterapia 20 . Em nosso estudo, não foi observada correlação entre o domínio dor e aspectos emocionais, acreditando-se na influência negativa dos aspectos emocionais na intensidade da dor crônica.…”