AAAPT Diagnostic Criteria for Acute Pain Following Breast Surgery

Abstract

Acute pain after breast surgery decreases the quality of life of cancer survivors. Previous studies using a variety of definitions and methods report prevalence rates between 10% and 80%, which suggests the need for a comprehensive framework that can be used to guide assessment of acute pain and pain-related outcomes after breast surgery. A multidisciplinary task force with clinical and research expertise performed a focused review and synthesis and applied the 5 dimensional framework of the AAAPT (Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks [ACTTION], American Academy of Pain Medicine [AAPM], American Pain Society [APS] Pain Taxonomy) to acute pain after breast surgery. Application of the AAAPT taxonomy yielded the following: 1) Core Criteria: Location, timing, severity, and impact of breast surgery pain were defined; 2) Common Features: Character and expected trajectories were established in relevant surgical subgroups, and common pain assessment tools for acute breast surgery pain identified; 3) Modulating Factors: Biological, psychological, and social factors that modulate interindividual variability were delineated; 4) Impact/Functional Consequences: Domains of impact were outlined and defined; 5) Neurobiologic Mechanisms: Putative mechanisms were specified ranging from nerve injury, inflammation, peripheral and central sensitization, to affective and social processing of pain. Perspective: The AAAPT provides a framework to define and guide improved assessment of acute pain after breast surgery, which will enhance generalizability of results across studies and facilitate meta-analyses and studies of interindividual variation, and underlying mechanism. It will allow researchers and clinicians to better compare between treatments, across institutions, and with other types of acute pain.

The role of regional anaesthesia and multimodal analgesia in the prevention of chronic postoperative pain: a narrative review

“…Consistency in the definition used for chronic pain can foster effective reproducibility and generalisability of preventative trials across different countries and healthcare settings. Using collaboratively created pain classification systems may align efforts across the research and clinical arenas, to provide a common framework for multiple types of acute and chronic pain, and with subsections for specific postoperative pain types [7, 8]. Pain disorders are classified based on traditional diagnostic categories but, importantly, for each pain type, five dimensions are defined: core criteria; common features; modifying factors; functional impact; and putative mechanisms [7–9], providing a framework for comparison of pain from different causes, including postoperative pain, and finding common elements to aid in treating it.…”

“…Biophysical factors include the extent of the surgical procedure and also the response of the patient's physiology to it. The amount of tissue damage, nerve damage and inflammation from operative and postoperative changes may influence chronic postoperative pain development, but patient characteristics such as age, sex and genetics have been proven to correspond to different degrees of chronic postoperative pain development [6,8,14]. Younger age and female sex are associated with increased risk of chronic postoperative pain.…”

AAAPT Diagnostic Criteria for Acute Low Back Pain with and Without Lower Extremity Pain

“…An initial presentation of findings was made to other acute pain WGs during the in-person AAAPT meeting to align definitions and categories among the dimensions and across other acute pain types. Consensus agreement of the AAAPT participants was reached for these conditions and definitions, as has been done with other AAAPT WGs [23,24]. Knowledge gaps were identified, and strategies to translate findings into research and clinical practice were formulated.…”

Pain, numbness, or both? Distinguishing the longitudinal course and predictors of positive, painful neuropathic features vs numbness after breast cancer surgery

“…The pain severity index (PSI) score is calculated using: PSI 5 S(Pain score at each site [0-10] 3 frequency [1][2][3][4][5]). 14,56,58,59 2.3. Assessment of sensory disturbance: positive neuropathic symptoms and numbness…”