Predictive factors for the development of persistent pain after breast cancer surgery

Previous studies have reported that 15% to 25% of patients treated for breast cancer experience long-term moderate-to-severe pain in the area of surgery, potentially lasting for several years. Few prospective studies have included all potential risk factors for the development of persistent pain aft...

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Bibliographic Details
Published in:Pain (Amsterdam) Vol. 156; no. 12; p. 2413
Main Authors: Andersen, Kenneth Geving, Duriaud, Helle Molter, Jensen, Helle Elisabeth, Kroman, Niels, Kehlet, Henrik
Format: Journal Article
Language:English
Published: United States 01.12.2015
Subjects:
Age Factors
Aged
Axilla
Breast Neoplasms - surgery
Chronic Pain - epidemiology
Cohort Studies
Female
Humans
Logistic Models
Longitudinal Studies
Lymph Node Excision - statistics & numerical data
Mastectomy - methods
Mastectomy - statistics & numerical data
Mastectomy, Segmental - statistics & numerical data
Mastodynia - epidemiology
Middle Aged
Neuralgia - epidemiology
Odds Ratio
Pain - epidemiology
Pain Measurement
Pain, Postoperative - epidemiology
Postoperative Complications - epidemiology
Preoperative Period
Prospective Studies
Risk Factors
Severity of Illness Index
ISSN:1872-6623, 1872-6623
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Summary:Previous studies have reported that 15% to 25% of patients treated for breast cancer experience long-term moderate-to-severe pain in the area of surgery, potentially lasting for several years. Few prospective studies have included all potential risk factors for the development of persistent pain after breast cancer surgery (PPBCS). The aim of this prospective cohort study was to comprehensively identify factors predicting PPBCS. Patients scheduled for primary breast cancer surgery were recruited. Assessments were conducted preoperatively, the first 3 days postoperatively, and 1 week, 6 months, and 1 year after surgery. A comprehensive validated questionnaire was used. Handling of the intercostobrachial nerve was registered by the surgeon. Factors known by the first 3 weeks after surgery were modeled in ordinal logistic regression analyses. Five hundred thirty-seven patients with baseline data were included, and 475 (88%) were available for analysis at 1 year. At 1-year follow-up, the prevalence of moderate-to-severe pain at rest was 14% and during movement was 7%. Factors associated with pain at rest were age <65 years (odds ratio [OR]: 1.8, P = 0.02), breast conserving surgery (OR: 2.0, P = 0.006), axillary lymph node dissection with preservation of the intercostobrachial nerve (OR: 3.1, P = 0.0005), moderate-to-severe preoperative pain (OR: 5.7, P = 0.0002), acute postoperative pain (OR: 2.8, P = 0.0018), and signs of neuropathic pain at 1 week (OR: 2.1, P = 0.01). Higher preoperative diastolic blood pressure was associated with reduced risk of PPBCS (OR: 0.98 per mm Hg, P = 0.01). Both patient- and treatment-related risk factors predicted PPBCS. Identifying patients at risk may facilitate targeted intervention.
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ISSN:1872-6623
1872-6623
DOI:10.1097/j.pain.0000000000000298