Chronic Breast Pain Prior to Breast Cancer Surgery Is Associated with Worse Acute Postoperative Pain Outcomes

Acute postoperative pain is associated with adverse short and long-term outcomes among women undergoing surgery for breast cancer. Previous studies identified preexisting pain as a predictor of postoperative pain, but rarely accounted for pain location or chronicity. This study leveraged a multinational pain registry, PAIN OUT, to: (1) characterize patient subgroups based on preexisting chronic breast pain status and (2) determine the association of preexisting chronic pain with acute postoperative pain-related patient-reported outcomes and opioid consumption following breast cancer surgery. The primary outcome was a composite score comprising the mean of pain intensity and pain interference items from the International Pain Outcomes Questionnaire. The secondary outcome was opioid consumption in the recovery room and ward. Among 1889 patients, we characterized three subgroups: no preexisting chronic pain (n = 1600); chronic preexisting pain elsewhere (n = 128) and; chronic preexisting pain in the breast with/without pain elsewhere (n = 161). Controlling for covariates, women with preexisting chronic breast pain experienced more severe acute postoperative pain and pain interference (β = 1.0, 95% CI = 0.7-1.3, p < 0.001), and required higher doses of opioids postoperatively (β = 2.7, 95% CI = 0.6–4.8, p = 0.013). Preexisting chronic breast pain may be an important risk factor for poor pain-related postoperative outcomes. Targeted intervention of this subgroup may improve recovery.

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Prevention of Acute Postoperative Pain in Breast Cancer: A Comparison between Opioids versus Ketamine in the Intraoperatory Analgesia

Pain Research and Management ◽

10.1155/2021/3290289 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Mirian López ◽

María Luz Padilla ◽

Blas García ◽

Javier Orozco ◽

Ana María Rodilla

Keyword(s):

Breast Cancer ◽

Postoperative Pain ◽

Rating Scale ◽

Numeric Rating Scale ◽

Cancer Surgery ◽

Breast Cancer Surgery ◽

Opioid Use ◽

Acute Postoperative Pain ◽

Systemic Side Effects ◽

Waking Up

Background. Acute postoperative pain (APP) has a high incidence in breast surgery, and opioids are the most commonly used drugs for its management; however, they are not free from systemic side effects, which may increase comorbidity. In the past few years, opioid-free anaesthesia has been favoured with promising results. Methods. We conducted a descriptive study including 71 patients who underwent breast cancer surgery. The opioid group (n = 41) received fentanyl for induction, remifentanil for maintenance, and rescue morphine before waking up, whereas the ketamine group (n = 30) received a ketamine bolus for induction followed by continuous ketamine infusion during surgery. Later, the presence and intensity of pain were registered, using the Numeric Rating Scale (NRS 1–10) for pain, at different times in the recovery room, at 24 hours and at 3 months. Results. Administration of ketamine is more effective than opioid use for APP prevention in breast cancer surgery because the ketamine group presented with less pain than the opioid group ( p < 0.05) at all measured times. When there was pain, patients in the ketamine group gave a lower score to its intensity ( p < 0.05). Conclusions. Ketamine could reduce the incidence of APP in breast cancer surgery, compared to opioids.

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Persistent Breast Pain Following Breast Cancer Surgery Is Associated With Persistent Sensory Changes, Pain Interference, and Functional Impairments

Journal of Pain ◽

10.1016/j.jpain.2014.08.014 ◽

2014 ◽

Vol 15 (12) ◽

pp. 1227-1237 ◽

Cited By ~ 14

Author(s):

Dale J. Langford ◽

Steven M. Paul ◽

Claudia West ◽

Jon D. Levine ◽

Deborah Hamolsky ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Surgery ◽

Pain Interference ◽

Breast Cancer Surgery ◽

Breast Pain ◽

Functional Impairments ◽

Sensory Changes

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A Double-blind Randomized Trial of Wound and Intercostal Space Infiltration with Ropivacaine during Breast Cancer Surgery

Anesthesiology ◽

10.1097/aln.0b013e31827d88d8 ◽

2013 ◽

Vol 118 (2) ◽

pp. 318-326 ◽

Cited By ~ 47

Author(s):

Aline Albi-Feldzer ◽

Emmanuelle Mouret-Fourme E ◽

Smail Hamouda ◽

Cyrus Motamed ◽

Pierre-Yves Dubois ◽

...

Keyword(s):

Breast Cancer ◽

Chronic Pain ◽

Neuropathic Pain ◽

Postoperative Pain ◽

Brief Pain Inventory ◽

Cancer Surgery ◽

Breast Cancer Surgery ◽

Postanesthesia Care Unit ◽

Wound Infiltration ◽

Double Blind

Abstract Background: The efficacy of local anesthetic wound infiltration for the treatment of acute and chronic postoperative pain is controversial and there are no detailed studies. The primary objective of this study was to evaluate the influence of ropivacaine wound infiltration on chronic pain after breast surgery. Methods: In this prospective, randomized, double-blind, parallel-group, placebo-controlled study, 236 patients scheduled for breast cancer surgery were randomized (1:1) to receive ropivacaine or placebo infiltration of the wound, the second and third intercostal spaces and the humeral insertion of major pectoralis. Acute pain, analgesic consumption, nausea and vomiting were assessed every 30 min for 2 h in the postanesthesia care unit and every 6 h for 48 h. Chronic pain was evaluated 3 months, 6 months, and 1 yr after surgery by the brief pain inventory, hospital anxiety and depression, and neuropathic pain questionnaires. Results: Ropivacaine wound infiltration significantly decreased immediate postoperative pain for the first 90 min, but did not decrease chronic pain at 3 months (primary endpoint), or at 6 and 12 months postoperatively. At 3 months, the incidence of chronic pain was 33% and 27% (P = 0.37) in the ropivacaine and placebo groups, respectively. During follow-up, brief pain inventory, neuropathic pain, and anxiety increased over time in both groups (P < 0.001) while depression remained stable. No complications occurred. Conclusion: This multicenter, prospective study shows that ropivacaine wound infiltration after breast cancer surgery decreased immediate postoperative pain but did not decrease chronic pain at 3, 6, and 12 months postoperatively.

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Prediction of Acute Postoperative Pain Following Breast Cancer Surgery Using the Pain Sensitivity Questionnaire

Clinical Journal of Pain ◽

10.1097/ajp.0000000000000380 ◽

2017 ◽

Vol 33 (1) ◽

pp. 57-66 ◽

Cited By ~ 18

Author(s):

Benno Rehberg ◽

Stanislas Mathivon ◽

Christophe Combescure ◽

Yannick Mercier ◽

Georges L. Savoldelli

Keyword(s):

Breast Cancer ◽

Postoperative Pain ◽

Pain Sensitivity ◽

Cancer Surgery ◽

Breast Cancer Surgery ◽

Acute Postoperative Pain

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Frequency and Presentations of Chronic Pain Following Breast Cancer Surgery: An Observational Study in a Tertiary Care Hospital of Pakistan

Case Medical Research ◽

10.31525/ct1-nct03961269 ◽

2019 ◽

Author(s):

Keyword(s):

Breast Cancer ◽

Chronic Pain ◽

Observational Study ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Cancer Surgery ◽

Breast Cancer Surgery ◽

Care Hospital

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Risk Factors for Chronic Pain Following Breast Cancer Surgery: A Prospective Study

Journal of Pain ◽

10.1016/j.jpain.2006.02.007 ◽

2006 ◽

Vol 7 (9) ◽

pp. 626-634 ◽

Cited By ~ 264

Author(s):

Ellen L. Poleshuck ◽

Jennifer Katz ◽

Carl H. Andrus ◽

Laura A. Hogan ◽

Beth F. Jung ◽

...

Keyword(s):

Breast Cancer ◽

Risk Factors ◽

Chronic Pain ◽

Prospective Study ◽

Cancer Surgery ◽

Breast Cancer Surgery ◽

A Prospective Study

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Differences in sleep disturbance, fatigue and energy levels between women with and without breast pain prior to breast cancer surgery

The Breast ◽

10.1016/j.breast.2012.07.007 ◽

2013 ◽

Vol 22 (3) ◽

pp. 273-276 ◽

Cited By ~ 14

Author(s):

Christina Van Onselen ◽

Bradley E. Aouizerat ◽

Laura B. Dunn ◽

Steven M. Paul ◽

Claudia West ◽

...

Keyword(s):

Breast Cancer ◽

Sleep Disturbance ◽

Energy Levels ◽

Cancer Surgery ◽

Breast Cancer Surgery ◽

Breast Pain

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Myofascial Massage for Chronic Pain and Decreased Upper Extremity Mobility After Breast Cancer Surgery

International Journal of Therapeutic Massage & Bodywork Research Education & Practice ◽

10.3822/ijtmb.v11i3.354 ◽

2018 ◽

Vol 11 (3) ◽

pp. 4-9 ◽

Cited By ~ 1

Author(s):

Jeanne Massingill, LMT, MLD, CST, KT, NMT ◽

Cara Jorgensen, LMT ◽

Jacqueline Dolata, MBA ◽

Ashwini R. Sehgal, MD

Keyword(s):

Breast Cancer ◽

Quality Of Life ◽

Chronic Pain ◽

Upper Extremity ◽

Outcome Measures ◽

Cancer Surgery ◽

Breast Cancer Surgery ◽

Mobility Limitations ◽

And Control

Background: Chronic localized pain and decreased upper extremity mobility commonly occur following breast cancer surgery and may persist despite use of pain medication and physical therapy.Purpose: We sought to determine the value of myofascial massage to address these pain and mobility limitations.Setting: The study took place at a clinical massage spa in the U.S. Midwest. The research was overseen by MetroHealth Medical Center’s Institutional Review Board and Case Center for Reducing Health Disparities research staff.Participants: 21 women with persistent pain and mobility limitations 3–18 months following breast surgery.Research Design: We conducted a pilot randomized controlled trial where intervention patients received myofascial massages and control patients received relaxation massages.Intervention: Intervention participants received 16 myofascial massage sessions over eight weeks that focused on the affected breast, chest, and shoulder areas. Control participants received 16 relaxation massage sessions over eight weeks that avoided the affected breast, chest, and shoulder areas. Participants completed a validated questionnaire at the beginning and end of the study that asked about pain, mobility, and quality of life.Main Outcome Measures: Outcome measures include change in self-reported pain, self-reported mobility, and three quality-of-life questions.Results: At baseline, intervention and control participants were similar in demographic and medical characteristics, pain and mobility ratings, and quality of life. Compared to control participants, intervention participants had more favorable changes in pain (-10.7 vs. +0.4, p < .001), mobility (-14.5 vs. -0.8, p < .001), and general health (+29.5 vs. -2.5, p = .002) after eight weeks. All intervention and control participants reported that receiving massage treatments was a positive experience.Conclusions: Myofascial massage is a promising treatment to address chronic pain and mobility limitations following breast cancer surgery. Further work in several areas is needed to confirm and expand on our study findings.

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