Almost half of all patients are affected by postoperative pain, study finds.
A recent Danish study suggests that long-term postoperative pain following breast cancer surgery is a pervasive problem affecting nearly half of breast cancer survivors. The most frequently affected areas were the breast region (86%), axilla (63%), arm (57%), and side of the body (56%).
From January to April 2008, questionnaires were completed by 3,253 women 18-70 years who had undergone surgery for unilateral primary breast cancer in Denmark between January 2005 and December 2006. Of the 47% reporting pain (n=1,543), 13% had severe pain, defined as a score of 8-10 on the 10-point rating scale. Of these women, 77% experienced pain daily. Another 39% reported moderate pain (scores of 4-7), 48% reported light pain (scores of 1-3), and 1% did not rate their pain.
Younger women (odds ratio [OR], 3.62 for ages 18 to 39 vs 60 to 69; P<0.001) and those who had axillary lymph node dissection (OR, 1.77 vs sentinel lymph node dissection; P<0.001) were significantly more likely to report pain. Adjuvant radiotherapy was also a predictor of persistent pain (breast tissue radiotherapy: OR, 1.50 vs locoregional radiotherapy + breast tissue/anterior thoracic radiotherapy: OR, 1.35; P=0.03).
In addition, 58% of women (n=1,882) reported sensory disturbances or discomfort. The most commonly affected areas were the axilla (66%), arm (52%), breast area (43%), and side of the body (30%). Younger women were at greater risk for sensory disturbances than older women (OR, 5.00 to 6.06, for breast-conserving surgery or mastectomy, respectively; both P<0.001), as were those who had axillary lymph node dissection (OR, 4.97 vs sentinel lymph node dissection; P<0.001). Also, 65% of women reporting sensory disturbances also reported pain vs 23% reporting pain without sensory disturbances, indicating that sensory disturbances and nerve injury were related to an increased risk of chronic pain (P<0.001).
The authors note that further studies of more diverse populations are needed; until then, approaches such as intraoperative, localized radiotherapy and nerve-sparing techniques during surgery may reduce the risk of developing chronic postoperative pain.
