Pain Persists After Breast Cancer Surgery

The burden of long-term pain after breast cancer surgery and its associated factors have been revealed

medwireNews: The majority of breast cancer patients continue to experience pain a year after surgery, say Finnish researchers who have identified key risk factors for this adverse outcome.

Their study, published in a research letter to JAMA, showed that just 34.5% of the 860 patients who completed a pain survey 1 year after resection or mastectomy had no pain, whereas 49.7% reported mild pain, 12.1% moderate pain, and 3.7% severe pain.

Logistic regression analysis using the worst pain at any site as an ordinal demonstrated that pain at this time point was significantly predicted by chronic pain before surgery (odds ratio [OR]=0.7), axillary surgery (OR=0.4) and receipt of chemotherapy (OR=1.47) or radiotherapy (OR=0.51).

Although the researchers did not assess the type of pain experienced 1 year after surgery in further detail, analysis of continuous variables also showed that preoperative pain in the region of surgery and depression before surgery were significantly linked to an increased risk of pain at 1 year.

By contrast, tumour risk prognosis, lymphovascular invasion from the primary tumour and use of hormone therapy before surgery were not significantly associated with pain at 1 year.

“These findings may be useful in developing strategies for preventing persistent pain following breast cancer treatment,” suggest Tuomo Meretoja, from Helsinki University Central Hospital, and co-authors.

They say that a risk assessment tool is needed to determine which patients might benefit from interventions to reduce pain at follow-up.

The study included patients who were aged less than 75 years (mean 57.3 years) and who underwent breast-conserving surgery or mastectomy plus axillary surgery for non-metastatic breast cancer between 2006 and 2010. The majority of patients also received chemotherapy (57%) and radiotherapy (73%).

Around a quarter of patients reported chronic pain from conditions such as fibromyalgia or lower back pain.

Reference

Meretoja TJ, Leidenius MH, Tasmuth T, et al. Pain at 12 months after surgery for breast cancer. JAMA 2014;311(1):90–2.

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