Persistent Pain Post Breast Cancer Surgery a Problem
Persistent pain following surgical treatment for breast cancer can be a significant problem for nearly half of all breast cancer survivors. Younger women and those who have an axillary lymph node dissection are most at risk.
Persistent pain after breast cancer surgery is often due to multiple mechanisms, including nerve damage related to surgical technique resulting in risk of intercostobrachial neuralgia, neuroma pain, or phantom breast pain.
Rune Gärtner, MD, of the University of Copenhagen, and colleagues population-based study is published in the Nov. 11 issue of the Journal of the American Medical Association. Their goal was to examine the prevalence, associated factors, and severity of chronic pain and sensory disturbances after surgery for breast cancer
The researchers used a 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. The study questionnaire was sent to the women between January and April 2008. None reported a breast cancer recurrence or other malignancy since the initial treatment.
Gärtner and colleagues found 1547 (47%) patients reported pain in at least one area of their body. Of these, 13% had severe pain, with a score of at least 8 on the 10-point scale. For them, daily pain was the norm (77%).
Of the patients reporting pain, 306 (20%) had contacted a physician within the prior 3 months due to pain, 439 (28%) had taken analgesics due to pain in the surgical area, and 397 (26%) had received other treatments for pain (ie, physiotherapy, massage).
The most common site of pain was the breast area (86%), followed by the axilla (63%), arm (57%), and side of the body (56%).
A total of 1265 women (40%) reported pain in other parts of the body/nonsurgical areas (eg, low back pain, headache). Pain complaints in nonsurgical areas were associated with a higher incidence of chronic postoperative pain because 810 women (65%) had pain in the surgical regions, whereas 674 women (37%) without pain in the nonsurgical area had pain in the surgical area.
Factors that predicted persistent pain were age younger than 40 (OR 3.62), axillary lymph node dissection (OR 1.77 versus sentinel lymph node dissection), and radiotherapy (OR 1.50 to 1.35).
Sensory disturbances can include allodynia, aftersensations, burning, or sensory loss, and appear linked to chronic pain.
The researchers noted that the study included few women on aromatase inhibitor treatment, which is known to cause muscular and joint pain. Further study is needed to determine how pain and sensory disturbances will develop or ease over time.
Prevalence of and factors associated with persistent pain following breast cancer surgery; JAMA 2009; 302: 1985-92.; Gärtner R, et al
Evaluating patients with chronic pain after breast cancer surgery: The search for relief; JAMA 2009; 302: 2034-35.; Loftus LS, Laronga C