scholarly journals Static mechanical allodynia in post-surgical neuropathic pain after breast cancer treatments

2020 ◽  
Vol 20 (4) ◽  
pp. 683-691
Author(s):  
Laura Mustonen ◽  
Tommi Aho ◽  
Hanna Harno ◽  
Eija Kalso
Keyword(s):  
Breast Cancer ◽  
Neuropathic Pain ◽  
Psychological Factors ◽  
Mechanical Allodynia ◽  
Cold Pressor Test ◽  
Pain Tolerance ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Cold Pain ◽  
Static Mechanical

AbstractObjectivesStatic mechanical allodynia (SMA), i. e., pain caused by normally non-painful static pressure, is a prevalent manifestation of neuropathic pain (NP). Although SMA may significantly affect the patient’s daily life, it is less well studied in the clinical context. We aimed to characterize SMA in women with chronic post-surgical NP (CPSNP) after breast cancer surgery. Our objective was to improve understanding of the clinical picture of this prevalent pain condition. This is a substudy of a previously published larger cohort of patients with intercostobrachial nerve injury after breast cancer surgery (Mustonen et al. Pain. 2019;160:246–56).MethodsWe studied SMA in 132 patients with CPSNP after breast cancer surgery. The presence, location, and intensity of SMA were assessed at clinical sensory examination. The patients gave self-reports of pain with the Brief Pain Inventory (BPI). We studied the association of SMA to type of surgery, oncological treatments, BMI, other pains, and psychological factors. General pain sensitivity was assessed by the cold pressor test.ResultsSMA was prevalent (84%) in this cohort whereas other forms of allodynia were scarce (6%). Moderate-to-severe SMA was frequently observed even in patients who reported mild pain in BPI. Breast and the side of chest were the most common locations of SMA. SMA was associated with breast surgery type, but not with psychological factors. Severe SMA, but not self-reported pain, was associated with lower cold pain tolerance.ConclusionsSMA is prevalent in post-surgical NP after breast cancer surgery and it may represent a distinct NP phenotype. High intensities of SMA may signal the presence of central sensitization.ImplicationsSMA should be considered when examining and treating patients with post-surgical NP after breast cancer surgery.

scholarly journals Thoracic Paravertebral Blockade Reduces Chronic Postsurgical Pain in Breast Cancer Patients: A Randomized Controlled Trial

Pain Medicine ◽  
2020 ◽  
Vol 21 (12) ◽  
pp. 3539-3547
Author(s):  
Zeng-Mao Lin ◽  
Mu-Han Li ◽  
Feng Zhang ◽  
Xue Li ◽  
Chun-Li Shao ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Randomized Controlled Trial ◽  
Neuropathic Pain ◽  
Controlled Trial ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Control Group ◽  
Single Shot ◽  
Randomized Controlled ◽  
Chronic Postsurgical Pain

Abstract Objective To evaluate the effect of multilevel single-shot thoracic paravertebral blockade (PVB) on the occurrence of chronic postsurgical pain (CPSP) in patients undergoing breast cancer surgery. Design A randomized controlled trial with two parallel groups. Setting A tertiary hospital. Methods Patients scheduled for breast cancer surgery were randomized to receive either ultrasound-guided multilevel single-shot PVB from T2 to T5 (the PVB group) or nothing (the control group). Surgery was then performed under general anesthesia. Patients were followed up for 12 months after surgery. The primary end point was incidence of CPSP at six months after surgery. Results A total of 218 patients were enrolled and randomized; of these, 208 and 204 completed six- and 12-month follow-up, respectively. The incidence of CPSP at six months was significantly lower in the PVB group (12.5% [13/104]) than in the control group (24.0% [25/104], relative risk = 0.52, 95% CI = 0.28–0.96, P = 0.031). Pain scores within 48 hours both at rest and with movement were lower in the PVB group than the control group (P = 0.006 and P < 0.001, respectively). The percentages of patients with neuropathic pain were also lower in the PVB group than the control group at both six and 12 months after surgery (P = 0.016 and 0.028, respectively). Adverse events did not differ between groups. Conclusions For patients undergoing breast cancer surgery, multilevel single-shot PVB reduces the incidence of CPSP at six months; it also improves early postoperative analgesia and reduces neuropathic pain at six and 12 months after surgery.

scholarly journals Presurgery Psychological Factors Predict Pain, Nausea, and Fatigue One Week After Breast Cancer Surgery

2010 ◽  
Vol 39 (6) ◽  
pp. 1043-1052 ◽  
Author(s):  
Guy H. Montgomery ◽  
Julie B. Schnur ◽  
Joel Erblich ◽  
Michael A. Diefenbach ◽  
Dana H. Bovbjerg
Keyword(s):  
Breast Cancer ◽  
Psychological Factors ◽  
Cancer Surgery ◽  
Breast Cancer Surgery

Identifying predictive factors for neuropathic pain after breast cancer surgery using machine learning

2020 ◽  
Vol 141 ◽  
pp. 104170
Author(s):  
Lamin Juwara ◽  
Navpreet Arora ◽  
Mervyn Gornitsky ◽  
Paramita Saha-Chaudhuri ◽  
Ana M. Velly
Keyword(s):  
Breast Cancer ◽  
Machine Learning ◽  
Neuropathic Pain ◽  
Predictive Factors ◽  
Cancer Surgery ◽  
Breast Cancer Surgery

Neuropathic pain following breast cancer surgery: proposed classification and research update

Pain ◽  
2003 ◽  
Vol 104 (1) ◽  
pp. 1-13 ◽  
Author(s):  
Beth F. Jung ◽  
Gretchen M. Ahrendt ◽  
Anne Louise Oaklander ◽  
Robert H. Dworkin
Keyword(s):  
Breast Cancer ◽  
Neuropathic Pain ◽  
Cancer Surgery ◽  
Breast Cancer Surgery

scholarly journals Radiofrequency Treatment of the Thoracic Paravertebral Nerve Combined with Glucocorticoid for Refractory Neuropathic Pain Following Breast Cancer Surgery

2009 ◽  
Vol 4;12 (4;7) ◽  
pp. E277-E283
Author(s):  
Ken-ichiro Uchida
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Neuropathic Pain ◽  
Pain Relief ◽  
Negative Impact ◽  
Case Series ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Radiofrequency Treatment

Background: Neuropathic pain following breast cancer surgery can have a profoundly negative impact on the physical and psychosocial functioning of patients. Radiofrequency treatment has been used as therapy for chronic pain, which also has a problem under debate of its neurodestructive nature. Although the efficacy and safety of using glucocorticoids in nerve block treatment are controversial, they have been used to treat neuropathic pain for many years and have been used to alleviate acute and continued postoperative pain. Neither radiofrequency combined with glucocorticoids nor radiofrequency treatment of the thoracic paravertebral nerve for neuropathic pain following breast cancer surgery has been reported. Objective: To describe the efficacy of thoracic paravertebral nerve radiofrequency treatment combined with glucocorticoids for refractory neuropathic pain following breast cancer surgery. Design: A series of 3 patients, who following breast cancer surgery with neuropathic pain that did not respond to conservative treatment, were selected. They received radiofrequency treatment of the thoracic paravertebral nerve combined with betamethasone. If pain remained after this treatment at a dermatome of a different level or at the same level, the same treatment was administered after at least 2 months had passed. Results: A total of 21 treatments were administered to the 3 patients. After these treatments, all 3 patients experienced pain relief and their quality of life improved as evaluated by the SF36. Hypoesthesia worsened slightly after treatment. However, anesthesia dolorosa and transient burning pain in the corresponding dermatome, which seemed to be related to neuro-injury after radiofrequency treatment, were not seen. Conclusion: This case series suggests that it is possible that radiofrequency treatment of the thoracic paravertebral nerve combined with glucocorticoid may help in pain relief and improve the quality of life of patients with refractory neuropathic pain following breast cancer surgery. Key words: Radiofrequency, neuropathic pain, glucocorticoid, breast cancer surgery, thoracic paravertebral nerve, postmastectomy pain

scholarly journals Sensory profiles in women with neuropathic pain after breast cancer surgery

2020 ◽  
Vol 182 (2) ◽  
pp. 305-315
Author(s):  
L. Mustonen ◽  
J. Vollert ◽  
A. S. C. Rice ◽  
E. Kalso ◽  
H. Harno
Keyword(s):  
Breast Cancer ◽  
Neuropathic Pain ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Sensory Profiles

scholarly journals Investigating the Factors Affecting the Severity of Neuropathic Pain Before and After the Coronavirus Infection in Patients Having Breast Cancer Surgery

2020 ◽  
Vol 9 (3) ◽  
pp. 190-194
Author(s):  
Saeid Charsouei ◽  
Loghman Ghaderi ◽  
Hassan Mohammadipour Anvari ◽  
Reza Eghdam Zamiri
Keyword(s):  
Breast Cancer ◽  
Neuropathic Pain ◽  
Breast Surgery ◽  
Short Form ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Disease Stage ◽  
Factors Affecting ◽  
Before And After ◽  
Coronavirus Infection

Objectives: Approximately one-third of women having breast surgery experience neuropathic pain although no study has so far identified its risk factors. It seems that the coronavirus infection increases the likelihood of neuropathic pain through influencing the neuropsychological system. Therefore, the current study aimed to investigate factors affecting the severity of neuropathic pain before and after coronavirus disease 19 (COVID-19) in patients who had breast cancer surgery. Materials and Methods: The current descriptive-analytical study was conducted six months before June 4, 2020. In total, 40 women having breast surgery participated in this study. Postoperative neuropathic pain and its influencing factors were evaluated using demographic tools, Spielberger anxiety, and a 36-item short-form health survey for measuring the quality of life (QoL). Finally, data were analyzed by multivariate regression. Results: Neuropathic pain significantly increased during the COVID-19 pandemic. Mastectomy (P=0.009), removal of lymph nodes (P=0.011), number of radiotherapy sessions (P=0.003), history of chemotherapy (P=0.009), disease stage (P=0.015), hidden anxiety (P=0.005), and explicit anxiety (P=0.001), and all domains of QoL (P<0.05) significantly predicted neuropathic pain. Conclusions: In general, adverse effects of coronavirus pandemic reduced the QoL while increasing anxiety (hidden and explicit), thus leading to an increase in the severity of postoperative neuropathic pain.

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