Persistent pain common long after breast cancer surgery
MedWire News: Approximately half of women who undergo surgery for primary breast cancer experience chronic pain or sensory disturbances in the surgical region during the first few years after surgery, Danish research shows.
Persistent pain and sensory disturbances following surgical treatment for breast cancer is a significant clinical problem that may be related to patient characteristics, surgical technique, and adjuvant therapy, note Rune Gärtner (University of Copenhagen) and colleagues.
In the present study, Gärtner and team assessed the prevalence, location, and severity of persistent pain and sensory disturbances in 3253 women aged 18 to 70 years, who had received surgery and adjuvant therapy (where indicated) for primary breast cancer an average of 26 months earlier.
The researchers found that 1543 (47%) patients reported pain in one or more areas, of whom 13% had severe pain, 39% had moderate pain, and 48% had light pain. Among women reporting severe pain, 77% experienced pain every day, whereas only 36% of women experiencing light pain had pain every day.
A total of 1882 (58%) patients reported sensory disturbances, most frequently in the axilla, followed by arm, breast area, and side of the body.
Young age (below 40 years) was significantly associated with a 3.6 and 5.0-fold increased likelihood for chronic pain and sensory disturbances, respectively, when compared with older age (60 to 69 years).
Axillary lymph node dissection was also associated with an increased likelihood for pain (odds ratio [OR]=1.77) and sensory disturbances (OR=4.97), when compared with sentinel lymph node dissection.
In addition, patients who received adjuvant radiotherapy were 1.5 times more likely to report pain than patients who did not receive radiotherapy. However, chemotherapy was not associated with an increased risk for persistent pain.
Gärtner and co-authors conclude in the Journal of the American Medical Association that chronic pain after breast cancer surgery and adjuvant therapy is probably related to intra-operative injury of the intercostobrachial nerve.
“Although breast conserving surgery and sentinel node dissection have reduced complaints, future strategies for further improvement should include nerve-sparing axillary dissection and attention to patients with other chronic pain symptoms,” they write.
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By Laura Dean