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Majority of women report pain 1 year after breast cancer surgery
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The majority of women who had undergone surgery for breast cancer reported some level of pain 1 year after the procedure, according to study results.
The analysis included 860 women aged younger than 75 years (mean age, 57.3 years) with unilateral nonmetastasized breast cancer treated at Helsinki University Central Hospital between 2006 and 2010. All patients underwent either breast-conserving surgery or mastectomy with axillary surgery. Researchers excluded patients who received neoadjuvant treatment, those who underwent immediate or delayed breast reconstruction, and those who had no breast cancer in the final histology.
Researchers sent a questionnaire to patients 1 year after surgery to assess the presence and intensity of pain.
Among the cohort, 73% of patients received radiotherapy and 57% received chemotherapy. Twenty-four percent reported having a chronic pain condition such as fibromyalgia and low back pain.
One year after surgery, 49.7% (95% CI, 46.3-53) of women reported mild pain, 34.5% (95% CI, 31.4%-37.8%) reported no pain, 12.1% (95%CI, 10-14.5) reported moderate pain and 3.7% (95% CI, 2.6-5.3) reported severe pain.
Researchers determined several patient-reported factors were significantly associated with pain at follow-up. They included chronic preoperative pain, preoperative pain in the area to be operated, preoperative depression, axillary lymph node dissection, and receipt of chemotherapy and/or radiotherapy.
“These findings may be useful in developing strategies for preventing persistent pain following breast cancer treatment,” the researchers wrote. “To identify patients who would benefit from preventive interventions, a risk assessment tool is needed.”
Disclosure: The researchers report consultant roles with Orion Pharma and Pharmaleads; lecture fees from Grunenthal, Janssen-Cilag, Merck Sharp & Dohme, Mundipharma, Orion Pharma and Pfizer; patents with Licentia and Orion Pharma; payment for the development of educational presentations from Grunenthal and Janssen-Cilag; and stock ownership in Orion Pharma.
Perspective
Back to TopCharles L. Shapiro, MD
Postoperative breast pain is common, with some women requiring narcotic analgesics for years. Little is known about predisposing factors or the natural history of this problem. Meretoja and colleagues have made a valuable contribution by briefly reporting the results of a large prospective trial of more than 800 women with early-stage breast cancers that included pre- and 12-month post-operation (lumpectomy or mastectomy) patient-reported pain assessments. The results show that 12% had moderate pain, 4% had severe pain and 50% had mild pain. Factors associated with pain at 12 months were axillary dissection, adjuvant chemotherapy, radiation, chronic preoperative pain and depression. These data support mounting trials dedicated to preventing post-operative pain, treating predisposing causes (eg, depression) and understanding precisely what causes the pain.
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