Sensory profiles in women with neuropathic pain after breast cancer surgery

Abstract

Purpose We performed a detailed analysis of sensory function in patients with chronic post-surgical neuropathic pain (NP) after breast cancer treatments by quantitative sensory testing (QST) with DFNS (German Research Network on Neuropathic Pain) protocol and bed side examination (BE). The nature of sensory changes in peripheral NP may reflect distinct pathophysiological backgrounds that can guide the treatment choices. NP with sensory gain (i.e., hyperesthesia, hyperalgesia, allodynia) has been shown to respond to Na +-channel blockers (e.g., oxcarbazepine). Methods 104 patients with at least "probable" NP in the surgical area were included. All patients had been treated for breast cancer 4-9 years ago and the handling of the intercostobrachial nerve (ICBN) was verified by the surgeon. QST was conducted at the site of NP in the surgical or nearby area and the corresponding contralateral area. BE covered the upper body and sensory abnormalities were marked on body maps and digitalized for area calculation. The outcomes of BE and QST were compared to assess the value of QST in the sensory examination of this patient group. Results Loss of function in both small and large fibers was a prominent feature in QST in the area of post-surgical NP. QST profiles did not differ between spared and resected ICBN. In BE, hypoesthesia on multiple modalities was highly prevalent. The presence of sensory gain in BE was associated with more intense pain. Conclusions Extensive sensory loss is characteristic for chronic post-surgical NP several years after treatment for breast cancer. These patients are unlikely to respond to Na +-channel blockers.

Classification of Qualitative Fieldnotes Collected During Quantitative Sensory Testing: A Step Towards the Development of a New Mixed Methods Approach in Pain Research

“…Previous studies have evaluated the degree of consensus between quantitative sensory testing and independent qualitative methods. [29][30][31][32][33][34] These studies have highlighted the lack of agreement between quantitative sensory testing and independent qualitative sensory testing, suggesting that these approaches are complementary rather than substitutive, and, taken as a whole, could combine the benefits of numbers with the benefits of a detailed description of the participants' experiences. Moreover, sensory perception and pain are personal phenomena experienced in an intimate and unique way by each individual; 35 this diversity ultimately contributes to an important variability between subjects among quantitative 21,24 and qualitative results, emphasizing the value of developing a personalized approach to sensory perception evaluation.…”

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

“…Other times, PMP can be because of a capsule formed following reconstruction or by lateral and medial pectoral nerves compressed by the pectoralis muscle, and to the detachment of the muscle serratus anterior compressed by the implant [11]. This condition is characterized by continuing pain, generally reported as "burning" and/or "shooting", associated with palpable allodynia [12]. PMP was considered in the past to be an infrequent problem, but more recently, it has been evaluated to be present in 13.5-25% of women who have undergone total or partial surgical breast excision, independent of mammary reconstruction [13].…”

Changes in Pain Sensitivity in Treatment for Breast Cancer: A 12-Month Follow-Up Case Series

“…The pain NRS has been widely used in combination with QST, which helped to identify a relationship between pain interference and intensity [ 15 , 29 , 32 ], as was observed in the current study. Despite the high prevalence of neuropathic pain in the population with breast cancer [ 18 , 45 , 53 , 55 ], none of the included women ended the study with neuropathic pain as measured with the LANSS.…”

“…It is possible, through the application of mechanical and thermal stimuli of controlled intensity, to detect signs of sensory gains and losses [ 23 , 24 ]. The scope for employing QST is broad, including in the evaluation of peripheral neuropathic pain syndromes [ 25 , 26 ], neurological pain [ 27 ], post-surgery pain syndromes [ 28 , 29 ], and musculoskeletal pain [ 30 ], among others. In terms of breast cancer, different QST modalities have been employed in both pre- and post-surgery interventions [ 15 , 31 , 32 ], during and after chemotherapy treatment [ 33 ], and in the presence of persistent neuropathic pain [ 29 ] and peripheral neuropathies [ 34 ].…”

“…The scope for employing QST is broad, including in the evaluation of peripheral neuropathic pain syndromes [ 25 , 26 ], neurological pain [ 27 ], post-surgery pain syndromes [ 28 , 29 ], and musculoskeletal pain [ 30 ], among others. In terms of breast cancer, different QST modalities have been employed in both pre- and post-surgery interventions [ 15 , 31 , 32 ], during and after chemotherapy treatment [ 33 ], and in the presence of persistent neuropathic pain [ 29 ] and peripheral neuropathies [ 34 ]. Among the findings of the above-mentioned studies using some of the QST psychophysical tests, the following are worth mentioning: a decrease in the pressure pain threshold (PPT) and the facilitation of temporal summation (TS), both during the post-surgical period [ 15 ] and in the presence of neuropathic pain [ 29 ], as well as a relationship of lower PPT with pain [ 32 ]; an increase in warmth detection and mechanical detection thresholds post-surgery [ 31 ], following chemotherapy [ 34 ], and in the presence of neuropathies [ 35 ]; and an increase in the vibratory detection threshold as a consequence of chemotherapy [ 34 , 35 ].…”