Persistent postsurgical pain has been shown to be clinically relevant in many patients undergoing various common operations, including breast cancer surgery. With breast cancer, the pathogenic mechanisms are multiple, including nerve damage related to surgical technique, according to background information in the article. Different types of sensory disturbances (e.g., aftersensations, burning, or sensory loss) can occur after other surgical procedures and may be an important part of the pain characteristics in breast cancer. "Pain has also been reported to be associated with adjuvant [supplemental] therapy, such as chemotherapy and radiotherapy," the authors write.
Rune Gärtner, M.D., of the University of Copenhagen, Denmark, and colleagues examined the prevalence, associated factors, and severity of chronic pain and sensory disturbances an average of 26 months after surgery for breast cancer of 3,754 women, ages 18 to 70 years, who received a questionnaire between January and April 2008. By June 2008, 87 percent (3,253) of eligible women returned the questionnaire.
The researchers found that a total of 1,543 patients (47 percent) reported pain in 1 or more areas, of which 13 percent reported severe pain, 39 percent reported moderate pain, and 48 percent reported light pain. Among women reporting severe pain, 77 percent experienced pain every day, whereas only 36 percent of women experiencing light pain had pain every day. Adjuvant radiation therapy, but not chemotherapy, increased the risk of reporting pain. Axillary lymph node dissection was associated with increased likelihood of pain or sensory disturbances, compared with sentinel lymph node dissection.
"There was a significant association of age on reporting pain, where young age was associated with higher risk, especially for patients receiving breast-conserving surgery (BCS), the risk being highest for those women aged 18 to 39 years receiving BCS compared with women aged 60 to 69 years," the authors write.
A total of 58 percent of the patients reported sensory disturbances or discomfort, with the most frequently reported areas the axilla (the underarm area), followed by arm, breast area and side of the body. A total of 306 patients (20 percent) with pain had contacted a physician within the prior 3 months for pain complaints in the surgical area.
"Based on the results of our study together with previously reported findings, chronic pain after breast cancer surgery and adjuvant therapy may predominantly be characterized as a neuropathic pain state and probably related to intraoperative injury of the intercostal-brachial nerve. In accordance with these findings, preliminary observations with nerve-sparing techniques may suggest such approaches to reduce the risk of developing a chronic neuropathic pain state. However, such studies need to be larger and more detailed, taking all the different subgroups as studied in our investigation into consideration," the researchers write.
. 2009;302:1985-1992. Available pre-embargo to the media at www.jamamedia.org
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Editorial: Evaluating Patients With Chronic Pain After Breast Cancer Surgery - The Search for Relief
In an accompanying editorial, Loretta S. Loftus, M.D., M.B.A., and Christine Laronga, M.D., of the
H. Lee Moffitt Cancer Center, Tampa, Florida, write regarding the importance of addressing pain after surgery.
"Patients at high risk for the development of postsurgical pain syndrome should be identified, should have therapy initiated early, and the effects of early intervention should be assessed. Management requires a multidisciplinary approach that includes evaluation by surgeons, medical oncologists, radiation oncologists, pain management specialists, psychologists and psychiatrists, social workers, and experts in rehabilitation medicine. Thus, the findings reported by Gärtner et al should prove helpful in the search for achieving effective relief of pain after breast cancer surgery."