Prevalence and intensity of persistent post-surgical pain following breast cancer surgery: a systematic review and meta-analysis of observational studies

Wang, Li; Cohen, Jared C.; Devasenapathy, Niveditha; Hong, Brian Y.; Kheyson, Sasha; Lu, Daniel; Oparin, Yvgeniy; Kennedy, Sean A.; Romerosa, Beatriz; Arora, Nikita; Kwon, Henry Y.; Jackson, Kate; Prasad, Manya; Jayasekera, Dulitha; Li, Allen; Guarna, Giuliana; Natalwalla, Shane; Couban, Rachel; Reid, Susan; Khan, James S.; McGillion, Michael; Busse, Jason W.

doi:10.1016/j.bja.2020.04.088

Cited by 83 publications

(74 citation statements)

References 67 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This pilot study has also highlighted some of the strengths of targeting a breast cancer population with a definitive large‐scale trial. The relatively high incidence of chronic postoperative pain we observed compared with mixed surgical populations is consistent with previous randomised trials and observational studies [34]. As Wang et al.…”

Section: Discussionsupporting

confidence: 91%

A pilot multicentre randomised controlled trial of lidocaine infusion in women undergoing breast cancer surgery

et al. 2021

View full text Add to dashboard Cite

Summary Chronic postoperative pain is common after breast cancer surgery. Peri‐operative lidocaine infusion may prevent the development of chronic postoperative pain, but a large‐scale trial is required to test this hypothesis. It is unclear whether a pragmatic, multicentre trial design that is consistent with expert guidance, addresses the limitations of previous studies, and overcomes existing translational barriers is safe, effective and feasible. We conducted a double‐blind, randomised controlled pilot study in 150 patients undergoing breast cancer surgery across three hospitals in Western Australia. Patients received lidocaine, or equivalent volumes of saline, as an intravenous bolus (1.5 mg.kg‐1) and infusion (2 mg.kg‐1.h‐1) intra‐operatively, and a subcutaneous infusion (1.33 mg.kg‐1.h‐1) postoperatively for up to 12 h on a standard surgical ward, with novel safety monitoring tools in place. The co‐primary outcomes were: in‐hospital safety events; serum levels of lidocaine during intravenous and subcutaneous infusion; and annualised enrolment rates per site with long‐term data capture. In‐hospital safety events were rare, and similar in the placebo and lidocaine arms (3% vs. 1%). Median (IQR [range]) serum lidocaine levels during intravenous (2.16 (1.74–2.83 [1.12–6.06]) µg.ml‐1, n = 41) and subcutaneous (1.52 (1.28–1.83 [0.64–2.85]) µg.ml‐1, n = 48) infusion were comparable with previous trials reporting improved pain outcomes. Annualised enrolment approximated 50 patients per site per year, with high levels of protocol adherence and ≥ 99% capture of outcomes at 3 and 6 months. The adjusted odds ratio (95%CI) for postoperative pain at 6 months in the lidocaine arm was 0.790 (0.370–1.684). We conclude that this trial, as designed, is safe, effective and feasible in patients undergoing breast cancer surgery, and a larger‐scale trial is planned.

show abstract

Section: Discussionsupporting

confidence: 91%

A pilot multicentre randomised controlled trial of lidocaine infusion in women undergoing breast cancer surgery

et al. 2021

View full text Add to dashboard Cite

show abstract

“…2 Chronic postsurgical pain (CPSP), defined as pain lasting for more than 3 months after surgery, 3 is frequently reported by patients undergoing breast cancer surgery (BCS), with a prevalence of up to 35%. 4 This pain may have a number of causes: the intercostobrachial nerve may be damaged, phantom and neuropathic pain may result from injury to the nerves, and neuromas may form in the scar tissue. [5][6][7] Some studies also suggested that women with breast cancer who undergo radiotherapy have a lifelong risk of developing chronic postsurgical neuropathic pain (CPSNP).…”

Section: Introductionmentioning

confidence: 99%

Paravertebral block for the prevention of chronic postsurgical pain after breast cancer surgery

Harkouk

Fletcher

Martinez

2021

Reg Anesth Pain Med

View full text Add to dashboard Cite

Patients frequently report chronic postsurgical pain (CPSP) after breast cancer surgery (BCS). The paravertebral block (PVB) is an effective technique to reduce acute postoperative pain after BCS, but its efficacy in preventing CPSP is unclear. This meta-analysis evaluates the efficacy of PVB in preventing CPSP after BCS. We searched Medline, Embase, CENTRAL, Database of Abstracts of Reviews of Effects, ClinicalTrials.gov, and WHO International Clinical Trials Registry Platform for studies comparing PVB with control for CPSP prevention after BCS, from inception to April 2020. The primary outcome was CPSP at 6 months, and the secondary outcomes were CPSP at 3 and 12 months, chronic postsurgical neuropathic pain (CPSNP) at 6 months, and PVB-related complications. Data were pooled and analyzed with a random-effects model, and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system was used to evaluate the certainty of evidence. A total of 12 studies were included in the study; data for the 6-month time point from 7 studies (2161 patients) were analyzed, and no difference was found between PVB and control in terms of efficacy in preventing CPSP after BCS (risk ratio (RR) 0.82 (95% CI 0.62 to 1.08)), with a moderate quality of evidence according to the GRADE system. Similar results were obtained at 3 and 12 months (RR 0.78 (95% CI 0.57 to 1.06), RR 0.45 (95% CI 0.14 to 1.41), respectively). Data for the 12-month time point from seven studies (2087 patients) were analyzed and showed that PVB protected against CPSNP, with low quality of evidence (RR 0.51 (95% CI 0.31 to 0.85)). In conclusion, CPSP was not found significantly prevented by PVB after BCS despite the limits in the included studies; nevertheless, PVB could prevent CPSNP by impacting the transition from acute to chronic pain.

show abstract

“…Indeed, it has been observed that, after breast surgery, women develop severe post-surgery pain and chronic post-mastectomy pain (PMP); among surviving women, from 25% to 60% of those who have been subjected to mastectomy for breast cancer suffer from post-surgery pain [3,4]. Other epidemiological data show that about half of all women undergoing mastectomy for breast cancer experience chronic pain, with 25% developing moderate-to-severe pain [5]. Chronic postmastectomy pain (PMP) is the main symptom of a syndrome referring to the occurrence of pain in and around the area of mastectomy lasting beyond three months after surgery when all other possible causes of pain are ruled out [6,7].…”

Section: Introductionmentioning

confidence: 99%

Post-Mastectomy Pain: An Updated Overview on Risk Factors, Predictors, and Markers

Calapai¹,

Esposito

Puzzo³

et al. 2021

Life

View full text Add to dashboard Cite

After breast surgery, women frequently develop chronic post-mastectomy pain (PMP). PMP refers to the occurrence of pain in and around the area of the mastectomy lasting beyond three months after surgery. The nature of factors leading to PMP is not well known. When PMP is refractory to analgesic treatment, it negatively impacts the lives of patients, increasing emotional stress and disability. For this reason, optimizing the quality of life of patients treated for this pathology has gained more importance. On the basis of the findings and opinions above, we present an overview of risk factors and predictors to be used as potential biomarkers in the personalized management of individual PMP. For this overview, we discuss scientific articles published in peer-reviewed journals written in the English language describing risk factors, predictors, and potential biomarkers associated with chronic pain after breast surgery. Our overview confirms that the identification of women at risk for PMP is fundamental to setting up the best treatment to prevent this outcome. Clinical practice can be planned through the interpretation of genotyping data, choosing drugs, and tailoring doses for each patient with the aim to provide safer and more effective individual analgesic treatment.

show abstract

Prevalence and intensity of persistent post-surgical pain following breast cancer surgery: a systematic review and meta-analysis of observational studies

Cited by 83 publications

References 67 publications

A pilot multicentre randomised controlled trial of lidocaine infusion in women undergoing breast cancer surgery

A pilot multicentre randomised controlled trial of lidocaine infusion in women undergoing breast cancer surgery

Paravertebral block for the prevention of chronic postsurgical pain after breast cancer surgery

Post-Mastectomy Pain: An Updated Overview on Risk Factors, Predictors, and Markers

Contact Info

Product

Resources

About