Predictors and Consequences of Multiple Persistent Postmastectomy Pains

Kudel, Ian; Edwards, Robert R.; Kozachik, Sharon; Block, Brian M.; Agarwal, Shefali; Heinberg, Leslie J.; Haythornthwaite, Jennifer A.; Raja, Srinivasa N.

doi:10.1016/j.jpainsymman.2007.01.013

Cited by 81 publications

(77 citation statements)

References 40 publications

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“…1,4,7 Furthermore, treatment principles are standardized at all Danish breast cancer departments according to European guidelines 8 and national protocols designed by the DBCG. 7 …”

mentioning

confidence: 99%

Prevalence of and Factors Associated With Persistent Pain Following Breast Cancer Surgery

Gärtner¹,

Jensen²,

Nielsen³

et al. 2009

JAMA

747

537

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Context Persistent pain and sensory disturbances following surgical treatment for breast cancer is a significant clinical problem. The pathogenic mechanisms are complex and may be related to patient characteristics, surgical technique, and adjuvant therapy.Objective To examine prevalence of and factors associated with persistent pain after surgical treatment for breast cancer. Design, Setting, and PatientsA nationwide cross-sectional questionnaire study of 3754 women aged 18 to 70 years who received surgery and adjuvant therapy (if indicated) for primary breast cancer in Denmark between January 1, 2005, and December 31, 2006. A study questionnaire was sent to the women between January and April 2008.Main Outcome Measures Prevalence, location, and severity of persistent pain and sensory disturbances in 12 well-defined treatment groups assessed an average of 26 months after surgery, and adjusted odds ratio (OR) of reported pain and sensory disturbances with respect to age, surgical technique, chemotherapy, and radiotherapy.Results By June 2008, 3253 of 3754 eligible women (87%) returned the questionnaire. A total of 1543 patients (47%) reported pain, of whom 201 (13%) had severe pain, 595 (39%) had moderate pain, and 733 (48%) had light pain. Factors associated with chronic pain included young age (18-39 years:

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“…1,4,7 Furthermore, treatment principles are standardized at all Danish breast cancer departments according to European guidelines 8 and national protocols designed by the DBCG. 7 …”

mentioning

confidence: 99%

Prevalence of and Factors Associated With Persistent Pain Following Breast Cancer Surgery

Gärtner¹,

Jensen²,

Nielsen³

et al. 2009

JAMA

747

537

View full text Add to dashboard Cite

show abstract

“…Preoperative risk factors associated with persistent pain following breast surgery include depression [172], anxiety [173], pain in any anatomic location [174] [110,[185][186][187][188][189]. Postoperative risk factors include radiation therapy [4,8,110,190,191] and increased severity of pain in the immediate postoperative period [4,191,192].…”

Section: Persistent Post-surgical (Chronic) Painmentioning

confidence: 99%

An Evidence-Based Review of the Efficacy of Perioperative Analgesic Techniques for Breast Cancer-Related Surgery

Cheng

2016

Pain Med

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Objective. To review the published evidence regarding perioperative analgesic techniques for breast cancer-related surgery.Design. Topical review.Methods. Randomized, controlled trials (RCTs) were selected for inclusion in the review. Also included were large prospective series providing estimates of potential risks and technical reports and small case series demonstrating a new technique or approaches of interest to clinicians.Results. A total of 514 abstracts were reviewed, with 284 studies meeting criteria for full review. The evidence regarding preemptive ketamine, scheduled opioids, perioperative non-steroidal anti-inflammatory drugs (NSAIDs), and intravenous lidocaine is mixed and deserves further investigation. There is strong evidence that both pregabalin and gabapentin provide analgesic benefits following breast surgery. There is minimal and conflicting data from highquality randomized, controlled studies suggesting that directly infiltrating and/or infusing local anesthetic (liposome encapsulated or unencapsulated) into the surgical wound is a reliably effective analgesic. In contrast, there is a plethora of data demonstrating the potent analgesia, opioid sparing, and decreased opioid-related side effects from thoracic epidural infusion and both single-injection and continuous paravertebral nerve blocks (the latter two demonstrating decreased persistent post-surgical pain between 2.5 and 12 months). Techniques with limited-yet promising-data deserving additional investigation include brachial plexus blocks, cervical epidural infusion, interfascial plane blocks, and interpleural blocks.Conclusions. While there are currently multiple promising analgesic techniques for surgical procedures of the breast that deserve further study, the only modalities demonstrated to provide potent, consistent perioperative pain control are thoracic epidural infusion and paravertebral nerve blocks.

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“…An increase in pain located in the breast and especially pain located in the shoulder and arm was seen, when the radiation field included supraclavicular glands and the axillary region. A recent study, including 278 breast cancer patients, has addressed the impact of different types of pain on the degree of disability and distress (Kudel et al, 2007). Three types of pain were studied: phantom breast pain, scar pain and other mastectomyrelated pain.…”

Section: (29%) and Carpenter Et Al In (1998) (27%)mentioning

confidence: 99%

The postmastectomy pain syndrome: an epidemiological study on the prevalence of chronic pain after surgery for breast cancer

et al. 2008

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The prevalence of the postmastectomy pain syndrome (PMPS) and its clinical characteristics was assessed in a group of patients who had undergone surgery for breast cancer at the Department of Surgery, Odense University Hospital, within the period of 1 May 2003 to 30 April 2004. The study included 258 patients and a reference group of 774 women. A questionnaire was mailed to the patients 1 1 2 year after surgery and to the women in the reference group. The PMPS was defined as pain located in the area of the surgery or ipsilateral arm, present at least 4 days per week and with an average intensity of at least 3 on a numeric rating scale from 0 to 10. The prevalence of PMPS was found to be 23.9%. The odds ratio of developing PMPS was 2.88 (95% confidence interval 1.84 -4.51). Significant risk factors were as follows: having undergone breast surgery earlier (OR 8.12), tumour located in the upper lateral quarter (OR 6.48) and young age (OR 1.04). This study shows that, although recent advances in the diagnostic and surgical procedures have reduced the frequency of the more invasive surgical procedures, there still is a considerable risk of developing PMPS after treatment of breast cancer.

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Predictors and Consequences of Multiple Persistent Postmastectomy Pains

Cited by 81 publications

References 40 publications

Prevalence of and Factors Associated With Persistent Pain Following Breast Cancer Surgery

Prevalence of and Factors Associated With Persistent Pain Following Breast Cancer Surgery

An Evidence-Based Review of the Efficacy of Perioperative Analgesic Techniques for Breast Cancer-Related Surgery

The postmastectomy pain syndrome: an epidemiological study on the prevalence of chronic pain after surgery for breast cancer

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