Predictive factors for the development of persistent pain after breast cancer surgery

Abstract

Previous studies have reported that 15% to 25% of patients treated for breast cancer experience long-term moderate-to-severe pain in the area of surgery, potentially lasting for several years. Few prospective studies have included all potential risk factors for the development of persistent pain after breast cancer surgery (PPBCS). The aim of this prospective cohort study was to comprehensively identify factors predicting PPBCS. Patients scheduled for primary breast cancer surgery were recruited. Assessments were conducted preoperatively, the first 3 days postoperatively, and 1 week, 6 months, and 1 year after surgery. A comprehensive validated questionnaire was used. Handling of the intercostobrachial nerve was registered by the surgeon. Factors known by the first 3 weeks after surgery were modeled in ordinal logistic regression analyses. Five hundred thirty-seven patients with baseline data were included, and 475 (88%) were available for analysis at 1 year. At 1-year follow-up, the prevalence of moderate-to-severe pain at rest was 14% and during movement was 7%. Factors associated with pain at rest were age <65 years (odds ratio [OR]: 1.8, P = 0.02), breast conserving surgery (OR: 2.0, P = 0.006), axillary lymph node dissection with preservation of the intercostobrachial nerve (OR: 3.1, P = 0.0005), moderate-to-severe preoperative pain (OR: 5.7, P = 0.0002), acute postoperative pain (OR: 2.8, P = 0.0018), and signs of neuropathic pain at 1 week (OR: 2.1, P = 0.01). Higher preoperative diastolic blood pressure was associated with reduced risk of PPBCS (OR: 0.98 per mm Hg, P = 0.01). Both patient- and treatment-related risk factors predicted PPBCS. Identifying patients at risk may facilitate targeted intervention.

Prevalence and risk factors associated with pain 21 months following surgery for breast cancer

“…The prevalence of pain at 21 months following surgery reported in our study is consistent with previous findings [2,8] as were the rates of moderate-to-severe persistent pain [8,10,27]. However, our findings differed to those of Andersen et al [11] who reported lower rates of moderate-to-severe pain in their cohort at rest and during movement at 1 year followup. The basis for these differences is not clear as inclusion criteria were similar for all studies.…”

“…Known independent risk factors for developing persistent pain following treatment for BC include younger age [3,[7][8][9][10][11], invasive surgical intervention [7,8,[11][12][13][14], high acute post-operative pain [8,13] and adjuvant radiation therapy following surgery [7,[12][13][14]; post-operative pain and neuropathic symptoms have also been implicated [11]. Recent studies have also identified higher body mass index [3,9,15], sleep disturbance, fatigue [12] as well as psychosocial factors [9,10,12] to be significantly associated with persistent pain.…”

“…Relatively few studies have investigated the prevalence of moderate-to-severe pain at long-term followup [8,10,11], and data on Australian populations are lacking. The aims of this study were therefore to (1) investigate the prevalence of pain, at different time points following BC surgery, including moderate-to-severe pain in an Australian population and (2) to identify which factors, present at 4 weeks post-BC surgery, were associated with the presence of pain at 21-month follow-up.…”

A Potential Role of Chronic Exposure to Extremely Low-Frequency Electromagnetic Fields in Triggering Persistent Pain Post Breast Cancer Surgery: A Review

“…Pain which can begin after surgery may last for several years or even permanently. [3][4][5][6][7] Breast cancer surgery ranks second to amputation of extremities for chronic neuropathic pain. Prevalence of PPBCS is as high as 65% in women between ages of 30 and 49; 40% in women between ages of 50 and 59 and 25% among women 60 years and older.…”

“…The established clinical grading system for PPBC reflects its heterogeneity and portends to a complex of interacting risk factors. [6,7] PPBCS can present with symptoms of sharp pain, burning pain, paresthesia, hyperesthesia and numbness, which can be exacerbated with quality and intensity of the noxious stimuli. [8] So far, a spectrum of clinical factors ranging from the method of surgical intervention, radiation therapy, the age of the affected person, body mass index, lymphedema and psychological factors, i.e.…”