Prospective cohort study assessing chronic pain in patients following minor surgery for breast cancer

Introduction The differentiation between acute and chronic pain can be insufficient for appropriate pain management. The aim of this study was to evaluate the prevalence of the predominant pain type (nociceptive, neuropathic, or central sensitization [CS] pain) in breast cancer survivors (BCS) with chronic pain. The secondary aims were to examine (1) differences in health‐related quality of life (HRQoL) between the different pain groups; and (2) the associations between patient‐, disease‐, and treatment‐related factors and the different pain types. Methods To determine the prevalence of the predominant type of pain, a recently proposed classification system was used. BCS were asked to complete the VAS for pain, Douleur Neuropathique 4 Questionnaire, Margolis Pain Diagram, Central Sensitization Inventory, and Short Form 36 (SF‐36). Results Ninety‐one BCS participated, among whom 25.3% presented neuropathic pain, 18.7% nociceptive pain, and 15.4% CS pain. Mixed pain was found in 40.6%. A significant intergroup difference in HRQoL was found for SF‐36 “general health” (P = 0.04). The odds for the presence of CS rather than nociceptive pain are 26 times higher in patients exposed to hormone therapy in comparison to the nonexposed (odds ratio 25.95, 95% confidence interval 1.33 to 504.37, P = 0.03). Conclusion Neuropathic pain is most frequent in BCS. Strong associations were found between CS pain and hormone therapy.

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“…Fuzier et al . demonstrated that 61% of the pain patients reported a neuropathic pain component 3 months after tumorectomy and SLNB.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, a broad spectrum of types of surgery can be held responsible for the development of chronic pain, such as mastectomy, amputation, thoracotomy, etc . Surgical treatment can cause neuropathic pain due to unintentional resection of a nerve or due to adhesions, inflammation, or fibrous tissue in the direct area of the nerve …”

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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“…The time interval was a variable inconsistently used in previous publications, thus explaining some of the variance in reported incidence of CPSP [13,21,36]. Some working groups defined CPSP as any pain (NRS/VAS >0), resulting in high proportions of patients affected by CPSP [7,10,11,16]. Others used NRS ≥3 or NRS ≥4 as cut-offs [1,9,14,27,37].…”

Section: Cpsp: Previous Researchmentioning

confidence: 99%

Pain-related functional interference in patients with chronic neuropathic postsurgical pain: an analysis of registry data

Stamer

Ehrler

Meißner

et al. 2019

Pain

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Although chronic postsurgical pain (CPSP) is a major health care problem, pain-related functional interference has rarely been investigated. Using the PAIN OUT registry we evaluated patients' pain-related outcomes on the first postoperative day, and their pain-related interference with daily living (Brief Pain Inventory) and neuropathic symptoms (DN4: douleur neuropathique en 4 questions) at six months after surgery. Endpoints were pain interference total scores (PITS) and their association with pain and DN4 scores. Furthermore, possible risk factors associated with impaired function at M6 were analyzed by ordinal regression analysis with PITS groups (no to mild, moderate and severe interference) as a dependent three-stage factor. Odds ratios (OR) with 95% confidence intervals (CI) were calculated. Of 2,322 patients, 15.3% reported CPSP with an average pain score ≥3 (NRS 0-10). Risk for a higher PITS group increased by 190% (OR (95%-CI): 2.9 (2.7-3.2); p<0.001) in patients with, compared to without CPSP. A positive DN4 independently increased risk by 29% (1.3 (1.12-1.45), p<0.001). Pre-existing chronic pain (3.6 (2.6-5.1); p<0.001), time spent in severe acute pain (2.9 (1.3-6.4); p=0.008), neurosurgical back surgery in males (3.6 (1.7-7.6); p<0.001) and orthopedic surgery in females (1.7 (1.0-3.0); p=0.036) were the variables with strongest association with PITS. PITS might provide more precise information about patients' outcomes than pain scores only. As neuropathic symptoms increase PITS, a suitable instrument for their routine assessment should be defined.

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“…The stark increase in opioid misuse has led to a growing body of research focusing on the prescribing of opioids for postoperative pain, with many finding that most of the opioids prescribed postoperatively go unused . Therefore, understanding opioid needs and prescribing patterns after specific operations is essential .…”

Section: Introductionmentioning

confidence: 99%

Pain and opioid prescriptions vary by procedure after breast surgery

Murphy

Thiels

Hanson

et al. 2019

Journal of Surgical Oncology

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Background: With the opioid epidemic in the United States, evaluating opioid prescribing patterns is essential. We evaluated opioids prescribed at discharge following breast surgery and their association with patient factors and pain scores. Methods:We retrospectively identified adult patients who underwent a mastectomy for cancer at Mayo Clinic sites from January 2010 to December 2016. Pain scores and prescription data were compared across operations and patient factors by univariate and multivariable analyses.Results: Of 4021 patients, 3782 (94.1%) received an opioid prescription. Median oral milligram morphine equivalents (MME) were similar across all site-specific procedure groups (medians ranging from 225 to 375) while pain scores ranged from 1 to 4.Patients undergoing bilateral mastectomy (BM) and immediate breast reconstruction (IBR) reported the greatest pain scores. Pain scores did not vary with age or diagnosis for patients undergoing unilateral mastectomy or BM with lymph node surgery and IBR procedures.On multivariable analysis, variables associated with a MME discharge prescription >Q 4 values included age, body mass index, site, year, inpatient status, and pain before discharge >3.Conclusion: Patient-reported pain following breast surgery varied by procedure, while MMEs prescribed remained similar. This suggests current opioid prescribing does not reflect intensity of pain and requires further research to optimize discharge opioid prescribing practices.

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Prospective cohort study assessing chronic pain in patients following minor surgery for breast cancer

Abstract: Pain persisted up to three months after minor surgery for breast cancer in 40% of patients with mostly a neuropathic component (61%).

Cited by 18 publications

References 26 publications

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

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

Pain-related functional interference in patients with chronic neuropathic postsurgical pain: an analysis of registry data

Pain and opioid prescriptions vary by procedure after breast surgery

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