A longitudinal study of painless and painful intercostobrachial neuropathy after breast cancer surgery

Cesa, S. La; Sammartino, Paolo; Mollica, Cristina; Cascialli, Gianluca; Cruccu, G.; Truini, Andrea; Framarino-dei-Malatesta, Marialuisa

doi:10.1007/s10072-018-3418-y

Cited by 9 publications

(14 citation statements)

References 23 publications

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“…[34][35][36][37][38][39] Regarding the criterion of comparability, most of the included studies controlled for pain as confounder. Only the studies of Andersen et al, 23 Henry et al, 40 Kalso et al, 48 and La Cesa et al 27 controlled for both pain and sensory disturbances. Detailed QST methodology was lacking for the studies of Hershman et al, 26 Kalso et al, 48 and La Cesa et al 27 Nonresponse rate during selection of participants or dropout was not described in 9 of the included studies.…”

Section: Methodological Qualitymentioning

confidence: 99%

“…Only the studies of Andersen et al, 23 Henry et al, 40 Kalso et al, 48 and La Cesa et al 27 controlled for both pain and sensory disturbances. Detailed QST methodology was lacking for the studies of Hershman et al, 26 Kalso et al, 48 and La Cesa et al 27 Nonresponse rate during selection of participants or dropout was not described in 9 of the included studies. 25,30,38,39,41,44,45,47 QST Methods and Results Within Women Treated for BC (AIM 1+2) Table 2 gives an overview of the QST methods applied in a population of women who had undergone unilateral surgery for BC and at which points the applied QST protocols differ from the standardized protocol as recommended by the DFNS.…”

Section: Methodological Qualitymentioning

confidence: 99%

“…In 6 articles, QST was applied to women surgically treated for BC but still undergoing adjuvant therapy for BC (radiotherapy and/or chemotherapy) (further in this review called BC patients). [23][24][25][26][27][28] In the remaining 22 articles, QST was applied to women who had completed primary treatment for BC (surgery and/or radiotherapy, and/or chemotherapy) (further in this review called BC survivors).…”

Section: Study Selection and Characteristicsmentioning

confidence: 99%

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Quantitative Sensory Testing in Women After Surgery for Breast Cancer

Dams

Gucht

Meeus

et al. 2021

The Clinical Journal of Pain

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Objectives: Quantitative sensory testing (QST) is a noninvasive technique to evaluate functioning of the somatosensory system. In many women surgically treated for breast cancer (BC), somatosensory functioning is disturbed with high prevalence of sensory loss and/or pain. The aims of this systematic review were (1) to summarize literature about QST methods; (2) to summarize the results within women surgically treated for BC (patients and survivors); (3) to compare QST results between women surgically treated for BC with and without pain; and (4) to compare the results between women surgically treated for BC and women without history of BC.Methods: A systematic literature search was conducted up to February 2020. Included studies had to report on QST methods (mechanical or thermal detection-pain thresholds, pressure pain thresholds [PPT], temporal summation [TS], or conditioned pain modulation [CPM]) in women over 18 years with-without pain, who had undergone unilateral surgery for BC.Results: Twenty-eight studies were included. Discrepancies in QST methods were greatest for TS and CPM. A local disturbance in thermal detection and an increased pain facilitation were found in BC survivors with pain in the surgical area. BC survivors with upper limb pain had significantly lower PPT at the surgical area and PPT were also significantly lower compared with women without history of BC, at affected and nonaffected sides for both local and remote body regions.Discussion: Standardized QST incorporating assessments of CPM is warranted in order to draw conclusions about neurobiological mechanisms of pain and somatosensory disturbances after surgical treatment for BC and to enhance mechanism-based management of these sequelae.

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Section: Methodological Qualitymentioning

confidence: 99%

Section: Methodological Qualitymentioning

confidence: 99%

Section: Study Selection and Characteristicsmentioning

confidence: 99%

See 1 more Smart Citation

Quantitative Sensory Testing in Women After Surgery for Breast Cancer

Dams

Gucht

Meeus

et al. 2021

The Clinical Journal of Pain

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“…It is considered as a peripheral sensitization phenotype with possible response to oxcarbazepine treatment [10,13]. It may reflect effective nerve regeneration [13], which could be hindered by radiotherapy after breast cancer surgery [35]. The high prevalence of radiotherapy in our cohort (90%) may partly explain the scarcity of "thermal hyperalgesia" phenotype.…”

Section: Quantitative Sensory Testingmentioning

confidence: 96%

Sensory profiles in women with neuropathic pain after breast cancer surgery

Mustonen

Vollert

Rice

et al. 2020

Breast Cancer Res Treat

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Purpose We performed a detailed analysis of sensory function in patients with chronic post-surgical neuropathic pain (NP) after breast cancer treatments by quantitative sensory testing (QST) with DFNS (German Research Network on Neuropathic Pain) protocol and bed side examination (BE). The nature of sensory changes in peripheral NP may reflect distinct pathophysiological backgrounds that can guide the treatment choices. NP with sensory gain (i.e., hyperesthesia, hyperalgesia, allodynia) has been shown to respond to Na +-channel blockers (e.g., oxcarbazepine). Methods 104 patients with at least "probable" NP in the surgical area were included. All patients had been treated for breast cancer 4-9 years ago and the handling of the intercostobrachial nerve (ICBN) was verified by the surgeon. QST was conducted at the site of NP in the surgical or nearby area and the corresponding contralateral area. BE covered the upper body and sensory abnormalities were marked on body maps and digitalized for area calculation. The outcomes of BE and QST were compared to assess the value of QST in the sensory examination of this patient group. Results Loss of function in both small and large fibers was a prominent feature in QST in the area of post-surgical NP. QST profiles did not differ between spared and resected ICBN. In BE, hypoesthesia on multiple modalities was highly prevalent. The presence of sensory gain in BE was associated with more intense pain. Conclusions Extensive sensory loss is characteristic for chronic post-surgical NP several years after treatment for breast cancer. These patients are unlikely to respond to Na +-channel blockers.

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“…Recently, a study demonstrated that patients with the ICBN preserved report less postoperative pain, paresthesia, or loss of sensation in the armpit and inner arm than patients who undergo ICBN injury or transection [ 23 ]. La Cesa et al have noted that sensory disturbances due to ICBN injury improve one year post-BC surgery, but neuropathic pain does not [ 24 ]. According to Chirappapha et al, ICBN preservation also benefits the upper limbs' physical function [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

From Cadaveric Dissection to the Operating Room: A Unilateral Double Intercostobrachial Nerve and the Implications in Axillary Lymph Node Dissection

Olivencia-Delgado¹,

Jusino-Álamo²,

Miranda-Sánchez³

et al. 2023

Cureus

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There are multiple treatment options for breast cancer (BC), including lumpectomy, chemo-and radiotherapy, complete mastectomy, and, when indicated, an axillary lymph node dissection. Such node dissections commonly lead the surgeon to encounter the intercostobrachial nerve (ICBN), which, if injured, leads to significant postoperative numbness of the upper arm. To assist in identifying the ICBN, we report a unilateral variation of a dual ICBN. The first ICBN (ICBN I) originates from the second intercostal space, as classically described in human anatomy. On the contrary, the second ICBN (ICBN II) originates from the second and third intercostal spaces. The anatomical knowledge of ICBN origin and its variations are crucial for axillary lymph node dissection in BC and other surgical interventions that involve the axillary region (e.g., regional nerve blocks). An iatrogenic injury of the ICBN has been associated with postoperative pain, paresthesia, and loss of upper extremity sensation in the dermatome supplied by this nerve. Therefore, maintaining the integrity of the ICBN is a worthy goal during axillary dissections in BC patients. Increasing the awareness of ICBN variants among surgeons reduces potential injuries, which would contribute to the BC patient's quality of life.

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A longitudinal study of painless and painful intercostobrachial neuropathy after breast cancer surgery

Cited by 9 publications

References 23 publications

Quantitative Sensory Testing in Women After Surgery for Breast Cancer

Quantitative Sensory Testing in Women After Surgery for Breast Cancer

Sensory profiles in women with neuropathic pain after breast cancer surgery

From Cadaveric Dissection to the Operating Room: A Unilateral Double Intercostobrachial Nerve and the Implications in Axillary Lymph Node Dissection

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