Predictors of persistent pain after breast cancer surgery: a systematic review and meta-analysis of observational studies

Wang, Li; Guyatt, Gordon; Kennedy, Sean A.; Romerosa, Beatriz; Kwon, Henry Y.; Kaushal, Alka; Chang, Yaping; Craigie, Samantha; Almeida, Carlos Podalírio Borges de; Couban, Rachel; Parascandalo, Shawn R.; Izhar, Zain; Reid, Susan; Khan, James S.; McGillion, Michael; Busse, Jason W.

doi:10.1503/cmaj.151276

Cited by 247 publications

(284 citation statements)

References 68 publications

(94 reference statements)

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“…Although this is an interesting finding, further evaluation is needed before drawing any definitive conclusions due to the small sample size of those who received preoperative radiation. On the other hand, while some previous studies suggested that axillary dissection was a risk factor for persistent pain,38 we were surprised to find that this was not the case in our cohort. This could be related to the low frequency of axillary dissection in our cohort, as well as the relatively small sample size.…”

Section: Discussioncontrasting

confidence: 90%

Risk factors for severe acute pain and persistent pain after surgery for breast cancer: a prospective observational study

Habib

Kertai

Cooter

et al. 2019

Regional Anesthesia &Amp; Pain Medicine

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Background and objectivesThere are few prospective studies providing comprehensive assessment of risk factors for acute and persistent pain after breast surgery. This prospective observational study assessed patient-related, perioperative, and genetic risk factors for severe acute pain and persistent pain following breast cancer surgery.MethodsWomen presenting for elective breast cancer surgery completed State Trait Anxiety Inventory, Beck Depression Inventory, and Pain Catastrophizing Scale questionnaires preoperatively. Diffuse noxious inhibitory control and mechanical temporal summation were assessed. A blood sample was obtained for genetic analysis. Analgesic consumption and pain scores were collected in the post-anesthesia care unit, and at 24 and 72 hours. Patients were contacted at 1, 3, 6, and 12 months to assess persistent pain. Primary outcome was maximum acute pain score in first 72 hours and secondary outcome was persistent pain.ResultsOne hundred twenty-four patients were included in analysis. Increased duration of surgery, surgeon, and higher pain catastrophizing scores were associated with increased severity of acute pain, while preoperative radiotherapy was associated with reduced severity. Persistent pain was reported by 57.3% of patients. Postdischarge chemotherapy (OR 2.52, 95% CI 1.13 to 5.82), postdischarge radiation (OR 3.39, 95% CI 1.24 to 10.41), severe acute pain (OR 5.39, 95% CI 2.03 to 15.54), and moderate acute pain (OR 5.31, 95% CI 1.99 to 15.30) were associated with increased likelihood of persistent pain.ConclusionsIncreased duration of surgery, higher pain catastrophizing score, and surgeon were associated with increased severity of acute pain. Preoperative radiation was associated with lower acute pain scores. Postsurgery radiation, chemotherapy, and severity of acute pain were associated with increased likelihood of persistent pain.Trial registration NCT03307525.

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Section: Discussioncontrasting

confidence: 90%

Risk factors for severe acute pain and persistent pain after surgery for breast cancer: a prospective observational study

Habib

Kertai

Cooter

et al. 2019

Regional Anesthesia &Amp; Pain Medicine

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“…35,36 In our study, we excluded those patients with pre-existing chronic pain in the chest area, and the indication for surgery does not usually contribute to preoperative pain. However, we do not have detailed information regarding other pre-existing pain conditions.…”

Section: Discussionmentioning

confidence: 99%

A Prospective Study of Chronic Pain after Thoracic Surgery

et al. 2017

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Background The goal of this study was to detect the predictors of chronic pain at 6 months after thoracic surgery from a comprehensive evaluation of demographic, psychosocial, and surgical factors. Methods Thoracic surgery patients were enrolled 1 week before surgery and followed up 6 months postsurgery in this prospective, observational study. Comprehensive psychosocial measurements were assessed before surgery. The presence and severity of pain were assessed at 3 and 6 months after surgery. One hundred seven patients were assessed during the first 3 days after surgery, and 99 (30 thoracotomy and 69 video-assisted thoracoscopic surgery, thoracoscopy) patients completed the 6-month follow-up. Patients with versus without chronic pain related to thoracic surgery at 6 months were compared. Results Both incidence (P = 0.37) and severity (P = 0.97) of surgery-related chronic pain at 6 months were similar after thoracotomy (33%; 95% CI, 17 to 53%; 3.3 ± 2.1) and thoracoscopy (25%; 95% CI, 15 to 36%; 3.3 ± 1.7). Both frequentist and Bayesian multivariate models revealed that the severity of acute pain (numerical rating scale, 0 to 10) is the measure associated with chronic pain related to thoracic surgery. Psychosocial factors and quantitative sensory testing were not predictive. Conclusions There was no difference in the incidence and severity of chronic pain at 6 months in patients undergoing thoracotomy versus thoracoscopy. Unlike other postsurgical pain conditions, none of the preoperative psychosocial measurements were associated with chronic pain after thoracic surgery.

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“…A study by Juhl et al [5] was in agreement with this study, and found no association between ALND and persistent pain. Several previous studies have demonstrated that ALND was a risk factor for developing persistent pain after breast cancer surgery [6,14,24,25].…”

Section: Discussionmentioning

confidence: 99%

Prevalence of persistent pain after breast cancer surgery and associated risk factors in Saudi women

Alosaimi¹,

Alosaimi²,

Alosaimi³

et al. 2017

IJMDC

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Background: Persistent pain is a sensation of burning in the arm, anterior chest, and axilla. This pain can persist for several years. The prevalence of persistent pain differs greatly. Several factors are associated with persistent pain after breast cancer surgery including age, body mass index, adjuvant therapy, preoperative pain, and axillary lymph node dissection. The aim of the study was to investigate the prevalence of persistent pain and its risk factors for females after their breast cancer surgery.

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Predictors of persistent pain after breast cancer surgery: a systematic review and meta-analysis of observational studies

Cited by 247 publications

References 68 publications

Risk factors for severe acute pain and persistent pain after surgery for breast cancer: a prospective observational study

Risk factors for severe acute pain and persistent pain after surgery for breast cancer: a prospective observational study

A Prospective Study of Chronic Pain after Thoracic Surgery

Prevalence of persistent pain after breast cancer surgery and associated risk factors in Saudi women

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