Feasibility and efficacy of sublingual buprenorphine tablets in managing acute postoperative pain after elective breast cancer surgeries: A series of 10 cases

Abstract Purpose Our study was designed to examine the possible relationship between gut microbiota, sleep disturbances, and acute postoperative pain. Methods Using 16S rRNA sequencing, we analyzed preoperative fecal samples from women undergoing breast cancer surgery. Preoperative sleep disturbance was evaluated with the Pittsburgh Sleep Quality Index (PSQI) questionnaire. Peak and average pain at rest and movement were evaluated 24 h after surgery, using a numerical rating scale (NRS). Preoperative symptoms of depression and anxiety were assessed with the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7), respectively. Inflammation was measured using white blood cell and neutrophil counts, together with platelet-lymphocyte ratio, and neutrophil-lymphocyte ratio. Results Preoperative sleep disturbance was associated with more severe acute postoperative pain. At the phylum level, women with poor sleep quality had higher relative abundance of Firmicutes (p = 0.021) and lower relative abundance of Bacteroidetes (p = 0.013). At the genus level, women with poor sleep quality harbored higher relative abundance of Acidaminococcus and lower relative abundance of several genera. The genus Alloprevotella was negatively associated with peak pain at movement during the first 24 h (r = − 0.592, p < 0.001). The genus Desulfovibrio was negatively associated with symptoms of anxiety (r = − 0.448, p = 0.006). However, partial correlations suggested that the relationship between Alloprevotella and peak pain at movement during the first 24 h was not statistically significant after controlling for sleep (r = − 0.134, p = 0.443). Conclusion These findings suggest that the changed gut microbiota may be involved in sleep-pain interaction and could be applied as a potential preventive method for postoperative pain. Trial registration The present clinical study has been registered on Chinese Clinical Trial Registry (www.chictr.org.cn); the clinical trial registration number is ChiCTR1900021730; the date of registration is March 7, 2019.

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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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Effect of Catechol-o-methyltransferase-gene (COMT) Variants on Experimental and Acute Postoperative Pain in 1,000 Women undergoing Surgery for Breast Cancer

Anesthesiology ◽

10.1097/aln.0000000000000013 ◽

2013 ◽

Vol 119 (6) ◽

pp. 1422-1433 ◽

Cited By ~ 36

Author(s):

Oleg Kambur ◽

Mari A. Kaunisto ◽

Emmi Tikkanen ◽

Suzanne M. Leal ◽

Samuli Ripatti ◽

...

Keyword(s):

Breast Cancer ◽

Postoperative Pain ◽

Pain Intensity ◽

Multiple Testing ◽

Pain Sensitivity ◽

Breast Cancer Surgery ◽

Nucleotide Polymorphisms ◽

Acute Postoperative Pain ◽

Cold Pain ◽

Methyltransferase Gene

Abstract Background: Catechol-O-methyltransferase (COMT) metabolizes catecholamines in different tissues. Polymorphisms in COMT gene can attenuate COMT activity and increase sensitivity to pain. Human studies exploring the effect of COMT polymorphisms on pain sensitivity have mostly included small, heterogeneous samples and have ignored several important single nucleotide polymorphisms (SNPs). This study examines the effect of COMT polymorphisms on experimental and postoperative pain phenotypes in a large ethnically homogeneous female patient cohort. Methods: Intensity of cold (+2-4°C) and heat (+48°C) pain and tolerance to cold pain were assessed in 1,000 patients scheduled for breast cancer surgery. Acute postoperative pain and oxycodone requirements were recorded. Twenty-two COMT SNPs were genotyped and their association with six pain phenotypes analyzed with linear regression. Results: There was no association between any of the tested pain phenotypes and SNP rs4680. The strongest association signals were seen between rs165774 and heat pain intensity as well as rs887200 and cold pain intensity. In both cases, minor allele carriers reported less pain. Neither of these results remained significant after strict multiple testing corrections. When analyzed further, the effect of rs887200 was, however, shown to be significant and consistent throughout the cold pressure test. No evidence of association between the SNPs and postoperative oxycodone consumption was found. Conclusions: SNPs rs887200 and rs165774 located in the untranslated regions of the gene had the strongest effects on pain sensitivity. Their effect on pain is described here for the first time. These results should be confirmed in further studies and the potential functional mechanisms of the variants studied.

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Can Acute Postoperative Pain Management After Tumour Resection Surgery Modulate Risk of Later Recurrence or Metastasis?

Frontiers in Oncology ◽

10.3389/fonc.2021.802592 ◽

2021 ◽

Vol 11 ◽

Author(s):

Aneurin Moorthy ◽

Aisling Ní Eochagáin ◽

Donal J. Buggy

Keyword(s):

Breast Cancer ◽

Postoperative Pain ◽

Acute Pain ◽

Regional Anaesthesia ◽

Primary Tumour ◽

Cancer Surgery ◽

Tumour Resection ◽

Total Intravenous Anaesthesia ◽

Acute Postoperative Pain ◽

Intravenous Anaesthesia

BackgroundCancer is a leading cause of mortality worldwide, but death is rarely from the primary tumour: Rather it is multi-organ dysfunction from metastatic disease that is responsible for up to 90% of cancer-related deaths. Surgical resection of the primary tumour is indicated in 70% of cases. The perioperative stress response, tissue hypoxia at the site of surgery, and acute pain contribute to immunosuppression and neo-angiogenesis, potentially promoting tumour survival, proliferation, and metastasis. Poorly controlled acute postoperative pain decreases Natural Killer (NK) immune cell activity, which could potentially facilitate circulating tumour cells from evading immune detection. This consequently promotes tumour growth and distal metastasis.MethodsWe conducted a comprehensive literature search for links between acute pain and cancer outcomes using multiple online databases. Relevant articles from January 1st, 2010 to September 1st, 2021 were analysed and appraised on whether postoperative pain control can modulate the risk of recurrence, metastasis, and overall cancer survival.ResultsAlthough experimental and retrospective clinical data suggest a plausible role for regional anaesthesia in cancer outcome modulation, this has not been supported by the single, largest prospective trial to date concerning breast cancer. While there are mixed results on anaesthesiology drug-related interventions, the most plausible data relates to total intravenous anaesthesia with propofol, and to systemic administration of lidocaine.ConclusionThe hypothesis that anaesthetic and analgesic technique during cancer surgery could influence risk of subsequent recurrence or metastasis has been prevalent for >15 years. The first, large-scale definitive trial among women with breast cancer found robust equivalent findings between volatile anaesthesia with opioid analgesia and regional anaesthesia. Therefore, while regional anaesthesia during tumour resection does not seem to have any effect on cancer outcomes, it remains plausible that other anaesthetic techniques (e.g. total intravenous anaesthesia and systemic lidocaine infusion) might influence oncologic outcome in other major tumour resection surgery (e.g. colorectal and lung). Therefore, another large trial is needed to definitively answer these specific research questions. Until such evidence is available, perioperative analgesia for cancer surgery of curative intent should be based on patient co-morbidity and non-cancer endpoints, such as optimising analgesia and minimising postoperative complications.

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Pain in 1,000 Women Treated for Breast Cancer

Anesthesiology ◽

10.1097/aln.0000000000000012 ◽

2013 ◽

Vol 119 (6) ◽

pp. 1410-1421 ◽

Cited By ~ 62

Author(s):

Mari A. Kaunisto ◽

Ritva Jokela ◽

Minna Tallgren ◽

Oleg Kambur ◽

Emmi Tikkanen ◽

...

Keyword(s):

Breast Cancer ◽

Chronic Pain ◽

Postoperative Pain ◽

Postoperative Analgesia ◽

Pain Sensitivity ◽

Experimental Pain ◽

Interindividual Variation ◽

Weak Correlation ◽

Acute Postoperative Pain ◽

Cold Pain

Abstract Background: This article describes the methods and results of the early part (experimental pain tests and postoperative analgesia) of a study that assesses genetic and other factors related to acute pain and persistent pain after treatment of breast cancer in a prospective cohort of 1,000 women. Methods: One thousand consenting patients were recruited to the study. Before surgery (breast resection or mastectomy with axillary surgery), the patients filled in questionnaires about health, life style, depression (Beck Depression Inventory), and anxiety (State-Trait Anxiety Inventory). They were also exposed to experimental tests measuring heat (43° and 48°C, 5 s) and cold (2-4°C) pain intensity and tolerance. Anesthesia was standardized with propofol and remifentanil, and postoperative analgesia was optimized with i.v. oxycodone. Results: The patients showed significant interindividual variation in heat and cold pain sensitivity and cold pain tolerance. There was a strong correlation between the experimental pain measures across the tests. Presence of chronic pain, the number of previous operations, and particularly state anxiety were related to increased pain sensitivity. Previous smoking correlated with decreased heat pain sensitivity. These factors explained 4–5% of the total variance in pain sensitivity in these tests. Oxycodone consumption during 20 h was significantly higher in patients who had axillary clearance. Oxycodone consumption had only a weak correlation with the experimental pain measures. Conclusions: Contact heat and cold pressure tests identify variability in pain sensitivity which is modified by factors such as anxiety, chronic pain, previous surgery, and smoking. High levels of anxiety are connected to increased pain sensitivity in experimental and acute postoperative pain. In a study of 1,000 women undergoing breast surgery for cancer, a small portion of the variance in preoperative response to noxious heat and cold testing could be explained by anxiety, the presence of chronic pain, and the number of previous operations. There was a weak correlation between response to experimental pain testing and acute postoperative pain, with largely similar predictive factors across both.

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

Journal of Clinical Medicine ◽

10.3390/jcm10091887 ◽

2021 ◽

Vol 10 (9) ◽

pp. 1887

Author(s):

Marium M. Raza ◽

Ruth Zaslansky ◽

Debra B. Gordon ◽

Jeanne M. Wildisen ◽

Marcus Komann ◽

...

Keyword(s):

Breast Cancer ◽

Chronic Pain ◽

Postoperative Pain ◽

Cancer Surgery ◽

Pain Interference ◽

Breast Cancer Surgery ◽

Breast Pain ◽

Acute Postoperative Pain ◽

Pain Outcomes ◽

Chronic Breast Pain

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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