scholarly journals Predictive Factors for Patients who Need Treatment for Chronic Post-Surgical Pain (CPSP) after Breast Cancer Surgery

2021 ◽  
Author(s):  
Yasuaki Uemoto ◽  
Megumi Uchida ◽  
Naoto Kondo ◽  
Yumi Wanifuchi-Endo ◽  
Takashi Fujita ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Recurrence ◽  
Japanese Version ◽  
Cancer Surgery ◽  
Breast Cancer Recurrence ◽  
Breast Cancer Surgery ◽  
Cross Sectional ◽  
Postsurgical Pain ◽  
Post Surgery ◽  
Chronic Postsurgical Pain

Abstract Purpose: Although chronic postsurgical pain (CPSP) after breast cancer surgery is a common and prevalent postsurgical adverse event, the need for CPSP treatment has not been investigated. This study examined the proportion of patients who needed treatment for CPSP and associated predictors. Methods: We conducted a cross-sectional study with female patients who underwent breast cancer surgery at our institution. Participants were aged ≤65 years at the time of this study and were at least 1 year post surgery. The questionnaire examined the presence of and need for treatment for CPSP and included the Japanese version of the Concerns about Recurrence Scale (CARS-J). Multivariate analyses were used to identify independent predictors of needing treatment for CPSP.Results: In total, 305 patients completed the questionnaire. The mean time since surgery was 67.1 months; 151 (51%) patients developed CPSP after breast cancer surgery and 61 (39%) needed treatment for CPSP. Among patients that developed CPSP, the fear of breast cancer recurrence as assessed by the CARS-J (odds ratio [OR] 2.22, 95% confidence interval [CI]: 1.30–3.81, P=0.004) and >2 postsurgical pain regions (OR 2.52, 95% CI: 1.16–5.57, P=0.020) were independent predictors of needing treatment for CPSP.Conclusions: This study is the first to identify the proportion and predictors of patients who need treatment for CPSP. Fear of breast cancer recurrence and >2 postsurgical pain regions may predict the need for CPSP treatment among patients following breast cancer surgery.

scholarly journals Can Acute Pain Treatment Reduce Postsurgical Comorbidity after Breast Cancer Surgery? A Literature Review

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Fumimasa Amaya ◽  
Toyoshi Hosokawa ◽  
Akiko Okamoto ◽  
Megumi Matsuda ◽  
Yosuke Yamaguchi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Acute Pain ◽  
Pain Treatment ◽  
Cancer Recurrence ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Regional Analgesia ◽  
Postsurgical Pain ◽  
Analgesic Regimen ◽  
Definition Of

Regional analgesia, opioids, and several oral analgesics are commonly used for the treatment of acute pain after breast cancer surgery. While all of these treatments can suppress the acute postsurgical pain, there is growing evidence that suggests that the postsurgical comorbidity will differ in accordance with the type of analgesic used during the surgery. Our current study reviewed the effect of analgesics used for acute pain treatments on the major comorbidities that occur after breast cancer surgery. A considerable number of clinical studies have been performed to investigate the relationship between the acute analgesic regimen and common comorbidities, including inadequate quality of recovery after the surgery, persistent postsurgical pain, and cancer recurrence. Previous studies have shown that the choice of the analgesic modality does affect the postsurgical comorbidity. In general, the use of regional analgesics has a beneficial effect on the occurrence of comorbidity. In order to determine the best analgesic choice after breast cancer surgery, prospective studies that are based on a clear definition of the comorbidity state will need to be undertaken in the future.

scholarly journals Paravertebral block for the prevention of chronic postsurgical pain after breast cancer surgery

2021 ◽  
pp. rapm-2020-102040
Author(s):  
Hakim Harkouk ◽  
Dominique Fletcher ◽  
Valeria Martinez
Keyword(s):  
Breast Cancer ◽  
Cancer Surgery ◽  
Paravertebral Block ◽  
Grade System ◽  
Breast Cancer Surgery ◽  
Quality Of Evidence ◽  
Postsurgical Pain ◽  
Chronic Postsurgical Pain ◽  
Time Point

Patients frequently report chronic postsurgical pain (CPSP) after breast cancer surgery (BCS). The paravertebral block (PVB) is an effective technique to reduce acute postoperative pain after BCS, but its efficacy in preventing CPSP is unclear. This meta-analysis evaluates the efficacy of PVB in preventing CPSP after BCS. We searched Medline, Embase, CENTRAL, Database of Abstracts of Reviews of Effects, ClinicalTrials.gov, and WHO International Clinical Trials Registry Platform for studies comparing PVB with control for CPSP prevention after BCS, from inception to April 2020. The primary outcome was CPSP at 6 months, and the secondary outcomes were CPSP at 3 and 12 months, chronic postsurgical neuropathic pain (CPSNP) at 6 months, and PVB-related complications. Data were pooled and analyzed with a random-effects model, and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system was used to evaluate the certainty of evidence. A total of 12 studies were included in the study; data for the 6-month time point from 7 studies (2161 patients) were analyzed, and no difference was found between PVB and control in terms of efficacy in preventing CPSP after BCS (risk ratio (RR) 0.82 (95% CI 0.62 to 1.08)), with a moderate quality of evidence according to the GRADE system. Similar results were obtained at 3 and 12 months (RR 0.78 (95% CI 0.57 to 1.06), RR 0.45 (95% CI 0.14 to 1.41), respectively). Data for the 12-month time point from seven studies (2087 patients) were analyzed and showed that PVB protected against CPSNP, with low quality of evidence (RR 0.51 (95% CI 0.31 to 0.85)). In conclusion, CPSP was not found significantly prevented by PVB after BCS despite the limits in the included studies; nevertheless, PVB could prevent CPSNP by impacting the transition from acute to chronic pain.

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 Effects of Intraoperative Low-Dose Ketamine on Persistent Postsurgical Pain after Breast Cancer Surgery: A Prospective, Randomized, Controlled, Double-Blind Study

2020 ◽  
Vol 1;23 (1;1) ◽  
pp. 37-47
Author(s):  
Ah-Reum Cho
Keyword(s):  
Breast Cancer ◽  
Study Design ◽  
Low Dose ◽  
Rating Scale ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Control Group ◽  
Double Blind Study ◽  
Postsurgical Pain ◽  
Number Of Patients

Background: Compared to acute postsurgical pain, studies regarding the role of ketamine in persistent postsurgical pain (PPSP) are limited. Objectives: The aim of this clinical trial was to test if intraoperative low-dose ketamine without postoperative infusion would reduce PPSP development after breast cancer surgery. Study design: We used a randomized, double-blinded, placebo study design. Setting: This study was conducted at Pusan National University Hospital, Republic of Korea, between December 2013 and August 2016. Methods: A total of 184 patients scheduled for breast cancer surgery were randomly assigned to either the control or ketamine group. Before skin incision, a bolus (0.5 mg/kg of ketamine or placebo), followed by a continuous infusion (0.12 mg/kg/h of ketamine or placebo), was administered until the end of the surgery. The patients were interviewed via telephone 1, 3, and 6 months after surgery. The first question was whether the patient had surgery-related pain. If answered affirmatively, questions from the Numeric Rating Scale for pain at rest (NRSr) and for coughing (NRSd) were also asked. Our primary outcome was the incidence of PPSP at 3 months after surgery. Results: For PPSP analysis, 168 patients were included. The number of patients who experienced pain was significantly lower in the ketamine group at 3 months (86.9% in the control group vs 69.0% in the ketamine group, P = .005) postoperatively. However, the NRSr and NRSd did not differ between the groups throughout the follow-up. Limitations: There were no postoperative low-dose ketamine infusion groups to compare due to hospital regulations. Dosage of ketamine was too low to reduce the severity of PPSP. And by using propofol and remifentanil for anesthesia, different results can be deduced with volatile anesthetics. Data from written questionnaires would have been more specific than telephone interviews for long-term assessment. Conclusions: Though intraoperative low-dose ketamine without postoperative infusion significantly reduced the incidence of PPSP up to 3 months after breast cancer surgery, it failed to reduce clinically significant PPSP and improve patients’ quality of life. Key words: Analgesia, breast cancer, chronic pain, ketamine, mastectomy, morphine, pain, postoperative, propofol

scholarly journals Assessment of quality of life in women five years after breast cancer surgery, members of Breast Cancer Self-Help Groups – non-randomized, cross-sectional study

2018 ◽  
Vol 22 (1) ◽  
pp. 20-26 ◽  
Author(s):  
Magdalena Sowa ◽  
Iwona Głowacka-Mrotek ◽  
Ewelina Monastyrska ◽  
Tomasz Nowikiewicz ◽  
Magdalena Mackiewicz-Milewska ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Cross Sectional Study ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Sectional Study ◽  
Cross Sectional ◽  
Self Help ◽  
Self Help Groups
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