Chronic Pain in Breast Cancer Survivors: Nociceptive, Neuropathic, or Central Sensitization Pain?

Leysen, Laurence; Adriaenssens, Nele; Nijs, Jo; Pas, Roselien; Bilterys, Thomas; Vermeir, Sofie; Lahousse, Astrid; Beckwée, David

doi:10.1111/papr.12732

Cited by 67 publications

(72 citation statements)

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“…In 18 (20.9%) patients with CPBS, the median NRS values recorded during movement were greater than ve, therefore re ecting moderate to severe chronic pain. These results are in line with those reported in the literature (Andersen and Kehlet 2013;Leysen et al 2018;Peuckmann et al 2009). Finally, according to the BPI questionnaire, CPBS had a profound impact on sleep quality, mood and perception of happiness.…”

Section: Discussionsupporting

confidence: 93%

Chronic pain after breast surgery: incidence, associated factors and impact on quality of life, an observational prospective study

Villa

Mandarano

Calabrisotto

et al. 2020

Preprint

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Background. Chronic pain after breast surgery (CPBS) has a disabling impact on postoperative health status. Mainly because of the lack of a clear definition, inconsistency does exist in the literature concerning both the actual incidence and the risk factors associated to CPBS. The aim of this prospective, observational study is to describe the incidence of and risk factors for CPBS, according to the definition provided by the IASP taskforce. The impact of CPBS on patients’ function and quality of life is also described. Methods. Adult female patients scheduled for oncological or reconstructive breast surgery at the Breast Unit of Careggi Hospital (Florence, Italy) were prospectively observed. Postoperative pain was evaluated at 2 months (“pain becoming chronic”) and at 3 months (CPBS) after surgery. Preoperative, intraoperative, and postoperative factors were compared in CPBS and No-CPBS groups through multivariate logistic regression analysis. Results. Among the 307 patients considered in this study, the incidence of “pain becoming chronic” was 25.4% [95%CI 20.6%-30.7%], while that of CPBS was 28% [95%CI 23.1%-33.4%]. The presence of pain at 2 months concords with the presence of CPBS at 3 months (Cohen k coefficient 0.63, IC95% 0.54-0.73). Results from the logistic regression analysis suggest that axillary surgery (OR [95%CI], 2.99 [1.13-7.87], p=0.03), preoperative use of pain medications (OR [95%CI], 2.04 [1.20-3.46], p=0.01), and higher dynamic NRS values at 6 hours postoperatively (OR [95%CI], 1.28 [1.05-1.55], p=0.01) were all independent predictors for CPBS. Conclusions. Chronic pain after breast surgery is a frequent complication. The presence of early pain at 2 months after surgery concords with the occurrence of CPBS. The possibility to early detect persistent pain, particularly in those patients at high risk for CPBS, might help physicians to more effectively prevent pain chronicization. In our cohort, long-term use of analgesics for preexisting chronic pain, axillary surgery, and higher dynamic NRS values at 6 hours postoperatively were all factors associated with increased risk of developing CPBS. Trial registration: clinicalTrials.gov registration NCT04309929

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Section: Discussionsupporting

confidence: 93%

Chronic pain after breast surgery: incidence, associated factors and impact on quality of life, an observational prospective study

Villa

Mandarano

Calabrisotto

et al. 2020

Preprint

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“…There are several reasons why the follow-up patients scored high on pain intensity or was not prescribed pain medications in accordance to their pain intensity and wanted more focus on pain. Studies have demonstrated that cancer survivors do have a significant symptom burden (33,34). In a busy clinic where both follow-up patients, patients receiving cancer treatment, and patients in palliative care setting are handled, the follow-up patients might not be given enough attention for their symptoms.…”

Section: Discussionmentioning

confidence: 99%

Pain management index (PMI)—does it reflect cancer patients’ wish for focus on pain?

Thronæs

Balstad

Brunelli

et al. 2019

Support Care Cancer

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Background: The Pain Management Index (PMI) was developed to combine information about the prescribed analgesics and the self-reported pain intensity in order to assess physicians' response to patients` pain. However, PMI has been used to explore undertreatment of cancer pain. The present study explores prevalence of negative PMI and its associations to clinical variables, including the patient-perceived wish for more attention to pain. Methods: A single-centre, cross-sectional observational study of cancer patients was conducted. Data on demographics and clinical variables, as well as patient-perceived wish for more attention to pain, were registered. PMI was calculated. Negative PMI indicates that the analgesics prescribed might not be appropriate to the pain intensity reported by the patient and associations to negative PMI were explored by logistic regression models. Results: 187 patients were included, 53% had a negative PMI score. Negative PMI scores were more frequent among patients with breast cancer (OR=4.2, 95% CI 1.3, 13.5), in a follow-up setting (OR 12.1, 95% CI 1.4, 101.4), and was inversely associated to low performance status (OR 0.14, 95% CI 0.03, 0.65). Twenty-two percent of patients with negative PMI scores reported that they wanted more focus on pain management versus 13 % among patients with a non-negative PMI score; the difference was not statistically significant. Conclusion: A high prevalence of negative PMI was observed, but only 1/5 of patients with a negative PMI wanted more attention to pain by their physician. Our findings challenge the use of PMI as a measure of undertreatment of cancer pain. Methods Study design This is a secondary analysis of a cross-sectional study among cancer in-patients and outpatients conducted in Mid-Norway in 2013-14 (1). Patients included in the study were admitted to St. Olavs Hospital, Trondheim University Hospital, a 800-bed referral centre. In general, cancer patients are treated at the Departments of Oncology, Surgery, Internal Medicine, and Gynaecology. All eligible cancer in-patients admitted to these departments were included at predefined days in the autumn of 2013. Outpatients were included from the Department of Oncology at predefined days in January 2014. Patients Inclusion criteria for the cross-sectional study were: adult cancer patients (age ≤ 18 years), no cognitive impairment (judged by the physician), and able to understand Norwegian language. Patients who had undergone surgical procedures the last 24 hours were excluded to minimize registration of transient symptoms related to surgery and anaesthesia. In the present secondary analysis, only patients who reported pain and /or were using analgesics were eligible. Data collection and assessment Data on primary cancer disease, metastatic pattern, comorbidity, Karnofsky Performance Status (KPS) (25), and current pain medications were collected by health care providers. The patients completed a questionnaire with information on gender, age, marital status, education, symptoms, and wishes for fo...

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“…They may arise shortly after surgery and/or adjuvant treatment and can remain as a source of physical and psychological distress for several years [11]. Consequently, shoulder morbidity and pain after breast cancer treatment have received considerable attention in the literature with several recent reviews examining the extent of these issues [6], [12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Absolute and relative reliability of pain sensitivity and functional outcomes of the affected shoulder among women with pain after breast cancer treatment

et al. 2020

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Breast cancer survivors (BCS) are often characterized by decreased pressure pain thresholds (PPT), range of motion (ROM) and strength in and around the shoulder affected by the treatment. This intra-rater reliability study was to establish the relative and absolute reliability of PPT's, active ROM and maximal isokinetic muscle strength (MIMS) of the affected shoulder in BCS with persistent pain after treatment. Methods Twenty-one BCS participated in the study. The PPTs of 17 locations and pain intensity were assessed using a pressure algometer and a numeric rating scale. The ROM was measured using a universal goniometer and MIMS was measured using an isokinetic dynamometer. Relative reliability was estimated using intra class correlation coefficient (ICC), and absolute reliability using standard error of measurement (SEM). Minimum detectable change (MDC) was calculated from SEM. Results The ICCs for PPTs ranged from 0.88-0.97, with SEM values ranging from 12.0 to 28.2 kPa and MDC ranging from 33.2 to 78.2 kPa. The ICCs for ROM ranged from 0.66-0.97, with SEM values ranging from 3.0 to 7.5˚and MDC ranging from 8.4 to 20.8˚. Finally, ICCs for MIMS ranged from 0.62-0.92, with SEM values ranging from 0.03 to 0.07 Nm/Kg FFM and MDC ranging from 0.09 to 0.19 Nm/kg FFM. Conclusion The results of this study indicate that PPTs, ROM and MIMS can be measured reliably on the affected shoulder in BCS with pain after treatment. This offer the possibility of using these measures to assess the effectiveness of interventions in this population.

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Chronic Pain in Breast Cancer Survivors: Nociceptive, Neuropathic, or Central Sensitization Pain?

Cited by 67 publications

References 71 publications

Chronic pain after breast surgery: incidence, associated factors and impact on quality of life, an observational prospective study

Chronic pain after breast surgery: incidence, associated factors and impact on quality of life, an observational prospective study

Pain management index (PMI)—does it reflect cancer patients’ wish for focus on pain?

Absolute and relative reliability of pain sensitivity and functional outcomes of the affected shoulder among women with pain after breast cancer treatment

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