Abstract
PurposeWe performed a detailed analysis of sensory function in patients with chronic post-surgical neuropathic pain (NP) after breast cancer treatments by quantitative sensory testing (QST) with DFNS (German Research Network on Neuropathic Pain) protocol and bed side examination (BE). The nature of sensory changes in peripheral NP may reflect distinct pathophysiological backgrounds that can guide the treatment choices. NP with sensory gain (i.e., hyperesthesia, hyperalgesia, allodynia) has been shown to respond to Na+-channel blockers (e.g., oxcarbazepine).Methods104 patients with at least “probable” NP in the surgical area were included. All patients had been treated for breast cancer 4–9 years ago and the handling of the intercostobrachial nerve (ICBN) was verified by the surgeon. QST was conducted at the site of NP in the surgical or nearby area and the corresponding contralateral area. BE covered the upper body and sensory abnormalities were marked on body maps and digitalized for area calculation. The outcomes of BE and QST were compared to assess the value of QST in the sensory examination of this patient group.ResultsLoss of function in both small and large fibers was a prominent feature in QST in the area of post-surgical NP. QST profiles did not differ between spared and resected ICBN. In BE, hypoesthesia on multiple modalities was highly prevalent. The presence of sensory gain in BE was associated with more intense pain.ConclusionsExtensive sensory loss is characteristic for chronic post-surgical NP several years after treatment for breast cancer. These patients are unlikely to respond to Na+-channel blockers.
Highlights
Chronic post-surgical neuropathic pain (NP, ICD 11 codes MG30.51 Chronic neuropathic pain after peripheral nerve injury and MG30.11 Chronic post cancer treatment pain) is common after breast cancer surgery with an estimated prevalence of 14–31% [1, 2]
In the DFNS Quantitative sensory testing (QST) of women with chronic post-surgical NP after breast cancer surgery, we found significant sensory loss in thermal and mechanical tests both in the affected and unaffected side when compared with the DFNS normative data
We describe DFNS QST sensory profiling and sensory mapping of patients with post-surgical NP several years after breast cancer treatments
Summary
Chronic post-surgical neuropathic pain (NP, ICD 11 codes MG30.51 Chronic neuropathic pain after peripheral nerve injury and MG30.11 Chronic post cancer treatment pain) is common after breast cancer surgery with an estimated prevalence of 14–31% [1, 2]. This condition may persist for years [3, 4]. The features of sensory dysfunctions in peripheral NP may reflect distinct pathophysiological backgrounds with different responses to medical treatments [8,9,10,11].
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