Abstract
BackgroundChronic pain after breast surgery (CPBS) has a disabling impact on postoperative health status. Mainly because of the lack of a clear definition, inconsistency does exist in the literature concerning both the actual incidence and the risk factors associated to CPBS. The aim of this prospective, observational study is to describe the incidence of and risk factors for CPBS, according to the definition provided by the IASP taskforce. The impact of CPBS on patients’ function and quality of life is also described.MethodsWomen aged 18+ undergoing oncological or reconstructive breast surgery from Jan until Apr 2018 at the Breast Unit of Careggi Hospital (Florence, Italy) were prospectively observed. Postoperative pain was measured at 0 h, 3 h, 6 h, 12 h, 24 h, 48 h, and 3 months (CPBS) after surgery. Preoperative, intraoperative, and postoperative factors were compared in CPBS and No-CPBS groups through multivariate logistic regression analysis.ResultsAmong the 307 patients considered in this study, the incidence of CPBS was 28% [95% CI 23.1–33.4%]. Results from the logistic regression analysis suggest that axillary surgery (OR [95% CI], 2.99 [1.13–7.87], p = 0.03), preoperative use of pain medications (OR [95% CI], 2.04 [1.20–3.46], p = 0.01), and higher dynamic NRS values at 6 h postoperatively (OR [95% CI], 1.28 [1.05–1.55], p = 0.01) were all independent predictors for CPBS.ConclusionsChronic pain after breast surgery is a frequent complication. In our cohort, long-term use of analgesics for pre-existing chronic pain, axillary surgery, and higher dynamic NRS values at 6 h postoperatively were all factors associated with increased risk of developing CPBS. The possibility to early detect persistent pain, particularly in those patients at high risk for CPBS, might help physicians to more effectively prevent pain chronicisation.Trial registrationClinicalTrials.gov registration NCT04309929.
Highlights
Chronic pain after breast surgery (CPBS) has a disabling impact on postoperative health status
The signs and symptoms associated with CPBS, and the use of patient-controlled analgesia (PCA) and rescue analgesia were explained to all breast surgery candidates
Patients lost in the follow-up had demographic characteristics and comorbidities not statistically different than those considered for the final analysis
Summary
Chronic pain after breast surgery (CPBS) has a disabling impact on postoperative health status. Several pathophysiological theories have been postulated to explain the development of chronic pain after surgery, including traumatic nerve injury, inflammation, and peripheral and central sensitisation (Urits et al 2020). These mechanisms seem pronounced in patients undergoing breast surgery. Because of the complex structure of the axillary and breast regions, nerve severance, compression, ischemia, stretching, and retraction during breast cancer operation, or from subsequent formation of a traumatic neuroma or scar tissue, unlikely preserve neural structures (Sarhadi et al 1996) All these factors contribute to the higher prevalence of chronic pain in breast surgery patients (Deumens et al 2013). Based on the pathophysiological mechanisms described above, some have suggested that a multimodal approach—involving, for instance, use of anti-inflammatory drugs (for preventing primary hyperalgesia) or locoregional anaesthesia (nerve blocks or epidural anaesthesia, for preventing secondary hyperalgesia and central nervous system sensitisation)—may limit the transition from acute to chronic pain (Urits et al 2020)
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