Chronic Postsurgical Pain Research Articles

Causes of chronic pain unrelated to surgical trauma after groin hernia repair: a prospective cohort study.

Chronic inguinal pain (CIP) can be caused by musculoskeletal or neurological pathologies and by surgical trauma after inguinal hernia repair among other. The aim of this prospective cohort observational study was to find the incidence and causes of CIP unrelated to surgical trauma 12 months after inguinal hernia repair. During sixteen months patients consulting a hernia center for groin-related symptoms were included in the study. Patients were evaluated by surgeons and filled out preoperatively the Inguinal Pain Questionnaires and a Numerical Rating Scale pain-questionnaire. For patients undergoing inguinal hernia repair, postoperative questionnaires similar to the pre-operative ones were sent out at 12 months. Patients scoring pain on pain questionnaires were evaluated by phone and physical examination. 289 patients (78.1%) of 370 repaired patients filled in the postoperative questionnaires. 62 (21.4%) patients scored pain, of these patients 5 (1.7%, 5/289) answered incorrectly in the pain questionnaires and 14 (4.8%, 14/289) had non-surgical trauma causes of pain: 5 musculoskeletal, 4 neurological and 3 other medical pathologies. This cohort study found CIP unrelated to surgical trauma in 4.8% of patients undergoing a groin hernia repair. Most causes of pain unrelated to surgical trauma were musculoskeletal and neurological pathologies. Nearly a third of patients scoring inguinal pain on pain-questionnaires did not have chronic post-surgical pain (CPSP), therefore incidence of CPSP should not be based solely on pain questionnaires. Clinical assessment of patients with pain is necessary to excluded CIP unrelated to the surgical trauma.

Safety and Efficacy of opioid-sparing Anesthesia Compared with Traditional opioid-anesthesia

Objectives: The rationale of adoption opioid sparing anesthesia (OSA) is to achieve perioperative analgesia with a minimal amount of opioid combined to non-opioid adjuvants during and after surgery, namely multimodal anesthesia. The OSA approach was originally developed to overcome the known complications of opioid-based anesthesia (OA) and the present scoping review (ScR) aims at providing the clinical evidence of safety and efficacy of OSA with respect to OA. Methods: This ScR is mainly focused on studies presenting evidence on the safety and efficacy of OSA versus OA. PubMed, EMBASE databases were utilized to find relevant studies. Search strategy included the following keywords: “opioid sparing anesthesia complications, opioid sparing anesthesia efficacy, opioid sparing anesthesia safety”. The findings from the 25 included studies were categorized into the following subsections: article characteristics, goals of the studies, OSA protocols, and surgical settings analyzed. Results: In the 25 reviewed studies, evidence related to the impact of OSA versus OA was considered. Intraoperative safety and efficacy endpoints include hemodynamic stability and anesthetic/analgesic requirements. Postoperative endpoints include early cognitive dysfunction, opioid-induced bowel disorder, the physical status of mothers and newborns after labor and emergency cesarean, systemic immune and inflammation modifications, postoperative recovery, in-hospital and long-term opioid requirement, early postoperative pain, chronic postsurgical pain. The studies reported a lower intraoperative mean arterial pressure and heart rate fluctuations when α2 agonists are adopted, while no differences were recorded for other complication rates. Analysis of OSA approaches for the postoperative conditions includes α2 agonists, NMDA receptor blocking agents, gabapentinoids, nefopam hydrocloride and locoregional anesthesia techniques with a positive impact on most of the endpoints considered. Discussion: The clinical implementation of OSA encompasses the perioperative use of non-opioid drugs and locoregional anesthesia techniques. The reviewed studies reported OSA as a feasible approach to reduce opioid-related complications with no impact on patient’s safety.

Chronic post-surgical pain after total knee arthroplasty: a narrative review.

Total knee arthroplasty (TKA) is an efficacious treatment for end-stage knee osteoarthritis, often accompanied by severe postoperative pain. In certain patients, this pain can persist for over 3months and is referred to as chronic post-surgical pain (CPSP). Postoperative persistent pain has emerged as a significant and noteworthy issue impacting patient quality of life following TKA. The etiology of CPSP after TKA is multifaceted. Peripheral or central sensitizations resulting from inflammatory reactions, nerve injury, and neurobiological mechanisms are the primary mechanisms contributing to chronic persistent pain after TKA. Preoperative, intraoperative, and postoperative factors can induce pain sensitization. Once CPSP occurs after TKA, it significantly hampers patient recovery with challenging treatment options. Currently, among the preventive and therapeutic strategies for chronic pain after TKA, it is widely believed that early comprehensive preventive treatment to prevent acute to chronic pain transition can substantially reduce the incidence of CPSP following TKA. In recent years, studies have investigated perioperative strategies aimed at reducing the occurrence of persistent pain after TKA. This article provides an overview of advancements in understanding the pathogenesis, high-risk factors, and preventive measures for chronic pain following TKA. We hope that this review will guide future research directions on CPSP after TKA while contributing to clinical perioperative pain management.

Understanding the Multifactorial Influences on Postsurgical Pain After Rotator Cuff Repair: A Retrospective Cohort Study.

The experience of chronic postsurgical pain (CPSP) can vary widely among patients after rotator cuff repair (RCR). To determine the prevalence and predictive factors of CPSP at 6 months after RCR. Cohort study; Level of evidence, 3. The following assessments were conducted preoperatively and 6 months postoperatively in adult patients with RCR who had undergone primary arthroscopic RCR (N = 1987): Constant score, pain assessed on the numeric rating scale (0-10), the Subjective Shoulder Value, the Oxford Shoulder Score, and quality of life as measured by the EuroQol-5 Dimensions-5 Level (EQ-5D-5L). Patient characteristics-including age, sex, body mass index, and smoking status-and surgical factors-including the duration of surgery and the American Society of Anesthesiologists (ASA) classification-were also reported. Multivariate logistic regression analysis was performed to determine which variables were predictors for CPSP. The prevalence of moderate to severe preoperative pain in the patients was 30.4% for CPSP. After adjusting for age, surgery duration, ASA classification, sex, and body mass index, results revealed that unique predictors for CPSP were as follows: (1) the presence of preoperative negative affect-assessed using the anxiety/depression dimension of the EQ-5D-5L (odds ratio [OR], 1.46 (P < .001); (2) preoperative pain (OR, 1.17; P < .001); and (3) shoulder function (OR, 0.96; P < .001). None of the surgical factors appeared to predict CPSP. Patients predisposed to CPSP can be identified during the preoperative phase. Collectively, there is a call for a more in-depth assessment of biopsychosocial risk factors that could substantially influence the postoperative pain experience.

Beyond the Surgery: The Impact of Coping Strategies on Persistent Pain After Rotator Cuff Repair.

Background: Rotator cuff repair is widely recognized as one of the most painful orthopedic surgeries, yet postoperative pain management in these patients is often underexplored. This study aimed to explore the relationship between pain outcomes and functional recovery six months after arthroscopic rotator cuff repair (ARCR), with a focus on the role of different pain coping mechanisms as mediators. Methods: This study included 83 patients that underwent rotator cuff repair. Pain levels were assessed using the Brief Pain Inventory (BPI-SF), while shoulder function was evaluated using the Oxford Shoulder Score (OSS). Coping strategies, including self-statements, ignoring pain, distraction, and praying, were examined in relation to pain severity and interference and were assessed with the Coping Strategies Questionnaire-Revised (CSQ-R). Simple and parallel mediation analyses were performed using the PROCESS macro to assess the mediating effects of coping mechanisms on the relationship between pain intensity, pain interference, and postoperative OSS. Results: Post-surgery, patients showed a significant improvement in OSS (from 29 ± 9 to 42 ± 6). At six months, 24% of patients reported chronic postsurgical pain (CPSP), defined as a pain severity score of 3 or higher. Correlation analyses revealed that OSS was negatively associated with pain catastrophizing (r = -0.35, p < 0.01) and praying (r = -0.28, p < 0.01). OSS was significantly negatively associated with pain severity (r = -0.54; p < 0.01) and pain interference (r = -0.51, p < 0.01). Mediation analysis demonstrated that coping self-statements significantly mediated the relationship between pain interference and shoulder function (a*b = 0.5266 (BootSE = 0.2691, 95% CI [0.1010, 1.1470]), emphasizing the important role of cognitive strategies in supporting recovery outcomes. Conclusion: Patients engaging in adaptive coping strategies, particularly coping self-statements, reported better functional outcomes. The findings underscore the importance of targeted interventions focusing on effective pain coping mechanisms to improve recovery post-ARCR.

Patient-reported outcomes, postoperative pain and pain relief after day case surgery (POPPY): methodology for a prospective, multicentre observational study.

In the UK, approximately 70% of surgical procedures are undertaken as day-cases. Little information exists about recovery from day-case surgery, yet international data highlights patients are at risk of developing significant longer-term health problems including chronic post-surgical pain and persistent postoperative opioid use. The Patient-reported Outcomes, Postoperative Pain and pain relief after daY case surgery (POPPY) study was a national prospective multicentre observational study, measuring short- and longer-term patient-reported outcomes, postoperative pain and pain relief after day-case surgery. This was a collaborative project led by resident anaesthetists under the Research and Audit Federation of Trainees umbrella. Adult day-case surgical patients were recruited on the day of surgery. Baseline data including patient characteristics; procedure details; pre-operative analgesic use; pre-existing pain; and quality of life scores were recorded. Patients were followed up through automated short message service messages. Short-term (postoperative days 1, 3 and 7) outcomes included: quality of recovery; pain severity; impact of pain on function; and analgesic use. Longer-term outcomes (postoperative day 97) included: quality of life; analgesic use; incidence of chronic post-surgical pain; and incidence persistent postoperative opioid use. Additional outcomes were completed by those patients with chronic post-surgical pain and persistent postoperative opioid use, with 30 patients recruited to a qualitative semi-structured interview study exploring postoperative expectations, recovery, postoperative pain and opioid use. An embedded pilot study at four sites recruited 129 patients. Responses to the automated short message service were gained from 129 patients (100%) at day 1; 116 (89.9%) at day 3; 108 (83.7%) at day 7; and 77 (59.7%) at day 97 postoperatively. The pilot enabled refinement of the methods and processes before the national roll out. This paper outlines the methods for the POPPY study, the largest UK multicentre prospective observational study considering short- and longer-term outcomes following day-case surgery.

A Randomized Controlled Trial of Adding Deep Parasternal Intercostal Plane Block to Interpectoral-Pectoserratus Plane Block in Breast Cancer Surgery.

The interpectoral-pectoserratus plane block is expected to anesthetize the lateral breast, but it is unclear whether the deep parasternal intercostal plane block may enhance recovery by providing analgesia to the medial breast. Patients undergoing breast cancer surgery were randomly assigned to receive either the interpectoral-pectoserratus block (single block) or interpectoral-pectoserratus combined with deep parasternal intercostal block (combined block). The primary outcome was the quality of recovery-15 questionnaire score assessed at 24 hours postoperatively. Secondary measures included dermatomal block assessment, pain severity, opioid consumption, opioid-related adverse events, hospital length of stay, and chronic postsurgical pain at 3 months after surgery. One hundred and sixteen patients were recruited, 58 in the single block group and 58 in the combined block group. There was no important difference in the 24-hour quality of recovery scores with mean (standard deviation [SD]) 123.6 (6.3) in the single block group and 123.2 (7.1) in the combined block group (mean difference, 0.4; 95% confidence interval [CI], -2.0 to 2.9; P =.731). There was greater dermatomal block on medial breast in the combined block group. There were no differences in other secondary outcomes. Addition of deep parasternal intercostal plane block was not superior to interpectoral-pectoserratus plane block alone for the quality of recovery in patients undergoing breast cancer surgery.

Incidence and risk factors for chronic pain following primary total knee arthroplasty in an irish surgical population.

To identify the incidence and characteristics of chronic post-surgical pain (CPSP) following total knee arthroplasty and determine peri-operative influencing factors. A representative, retrospective random sample was taken of patients who underwent total knee arthroplasty in the South Infirmary University Hospital Cork for an 18-month period. Two hundred fourteen patient charts were reviewed out of a total of 507 charts for that period to provide a 90% confidence interval. The incidence of CPSP in an Irish population 6months after total knee arthroplasty was found to be 36.5%. The following factors were found to be statistically significant with respect to the incidence of CPSP: female sex, lack of multimodal analgesia (consisting of paracetamol, NSAID, and opioids), general anaesthesia, and lower Oxford Knee Scores at 6months post-surgery. Age, the knee operated on, ASA grade, or greatest acuity pain, were not found to be statistically significant factors in the development of CPSP. CPSP is common after total knee arthroplasty with an incidence of 36.5% at 6months post procedure. Female sex, lack of multimodal analgesia, and lower Oxford Knee Scores were associated with increased CPSP.

Impact of general anesthesia type on chronic postsurgical pain following video-assisted thoracoscopic surgery for lung cancer: a retrospective propensity-matched cohort study.

Anesthetic agents are potential modifiable factors that can mitigate chronic postsurgical pain (CPSP) development. This study aimed to investigate the association between propofol-based total intravenous anesthesia (TIVA) and the occurrence of CPSP following video-assisted thoracoscopic surgery (VATS) for lung cancer resection. This single-center retrospective cohort study included adult patients with lung cancer who underwent elective VATS between January 2018 and December 2022. Patients were divided based on the maintenance anesthetic used (propofol vs. sevoflurane). The primary outcome was the presence of CPSP, defined as any level of surgical site pain recorded within 3-6 months postoperatively. The authors investigated the association between anesthetic agents and CPSP using propensity score matching with stabilized inverse probability of treatment weighting (sIPTW) to adjust for confounders. Additionally, multivariable logistic regression was used to further adjust for intraoperative opioid use that sIPTW could not account for. The robustness of these associations was evaluated using the E-value. Of the 833 patients analyzed, 461 received propofol and 372 sevoflurane. The overall incidence of CPSP was 43.3%. After sIPTW, the use of TIVA was significantly associated with a lower incidence of CPSP (odds ratio [OR]: 0.75, 95% confidence interval [CI]: 0.57-0.99, P = 0.041), and remained significant after adjusting for intraoperative remifentanil equivalent dose (OR: 0.73, 95% CI: 0.55-0.96, P = 0.026). The E-values were 1.08 and 1.17, respectively. Propofol-based TIVA is associated with reduced CPSP occurrence in VATS for lung cancer. Further prospective studies are needed to confirm the results.

Current concepts and targets for preventing the transition of acute to chronic postsurgical pain.

It is estimated that approximately a third of patients undergoing certain surgeries may report some degree of persistent pain postoperatively. Chronic postsurgical pain (CPSP) reduces quality of life, is challenging to treat, and has significant socio-economic impact. From an epidemiological perspective, factors that predispose patients to the development of CPSP may be considered in relation to the patient, the procedure or, the care environment. Prevention or management of transition from acute to chronic pain often need a multidisciplinary approach beginning early in the preoperative period and continuing beyond surgical admission. The current concepts regarding the role of central and peripheral nervous systems in chronification of pain may provide targets for future therapies but, the current evidence seems to suggest that a multimodal analgesic approach of preventive analgesia along with a continued follow-up and treatment after hospital discharge may hold the key to identify and manage the transitioning of acute to chronic pain. A comprehensive multidisciplinary approach with prior identification of risk factors, minimizing the surgical insult and a culture of utilizing multimodal analgesia and continued surveillance beyond the period of hospitalization is an important step towards reducing the development of chronic pain. A transitional pain service model may accomplish many of these goals.

Identifying predictive factors of the development of chronic post-surgical pain (CPPS)

Identifying predictive factors of the development of chronic post-surgical pain (CPPS)

From pain level to pain experience: redefining acute pain assessment to enhance understanding of chronic postsurgical pain

BackgroundChronic postsurgical pain (CPSP) significantly impairs quality of life and poses a substantial healthcare burden, affecting up to a quarter of patients undergoing surgery. Although acute pain is recognised as a predictor for CPSP development, the role of patient experience remains underexplored. This study examines the predictive value of patient experience alongside traditional risk factors for CPSP after orthopaedic surgery. MethodsAn exploratory analysis was conducted on 294 patients from a multicentre randomised clinical trial comparing continuous perineural analgesia and single-injection nerve block in ambulatory orthopaedic surgeries. Patient experience was assessed using the Evaluation du Vecu de l’Anesthésie Générale (EVAN-G) validated questionnaire. Factors associated with CPSP at 90 days after surgery were identified through univariate and multivariate analyses, incorporating patient-reported outcomes and classical variables. ResultsOut of 219 patients with complete data, 63 (29%) developed CPSP at day 90. Multivariate analysis revealed a poor pain experience, as assessed by the pain dimension of EVAN-G on postoperative day 2, as an independent predictor of CPSP (odds ratio 6.45, 95% confidence interval 1.65–25.26, P<0.01). Poor pain experience was associated with an augmented risk of CPSP. ConclusionsThis study underscores the role of patient-reported outcomes, specifically the pain experience dimension captured by the EVAN-G scale, in prediction of CPSP 90 days after surgery. It suggests a shift from conventional assessments of pain intensity to a comprehensive understanding of pain experience, advocating for tailored pain management approaches that could reduce chronic pain, thereby improving patient quality of life and functional recovery.

Prospective Study of Preoperative Negative Affect and Postoperative Pain in Patients Undergoing Thoracic Surgery: The Moderating Role of Sex.

Objective: Preoperative negative affect is a risk factor for worse postoperative pain, but research investigating this association among patients undergoing thoracic surgery is inconsistent. Additionally, female patients often report greater negative affect and postoperative pain than males. This prospective observational study investigated the association between preoperative negative affect and postoperative pain after thoracic surgery and whether this association differed by sex. Methods: Patients (n = 105) undergoing thoracic surgery completed preoperative assessments of pain and negative affect (PROMIS anxiety and depression short forms). Patients reported their daily worst pain over the first 7 postoperative days, and an index score of acute postoperative pain was created. Six months after surgery, a subsample of patients (n = 60) reported their worst pain. Results: Higher levels of preoperative anxiety (r = 0.25, p = 0.011) and depression (r = 0.20, p = 0.042) were associated with greater acute postoperative pain, but preoperative negative affect was not related to chronic postsurgical pain (anxiety: r = 0.19, p = 0.16; depression: r = -0.01, p = 0.94). Moderation analyses revealed that the associations between both preoperative anxiety (b = 0.12, 95% CI [0.04, 0.21], p = 0.004) and depression (b = 0.15, 95% CI [0.04, 0.26], p = 0.008) with acute postoperative pain were stronger among females than males. Similarly, the association between preoperative anxiety and chronic postsurgical pain was stronger among females (b = 0.11, 95% CI [0.02, 0.20], p = 0.022), but the association between preoperative depression and chronic pain did not differ based on sex (b = 0.13, 95% CI [-0.07, 0.34], p = 0.201]). Conclusions: Our findings suggest that negative affect may be especially important to the experience of pain following thoracic surgery among female patients, whose degree of preoperative anxiety may indicate vulnerability to progress to a chronic pain state. Preoperative interventions aimed at reducing negative affect and pain may be particularly useful among females with high negative affect before thoracic surgery.

From Healing to Hurting: Addressing Sex- and Gender-Based Differences in Chronic Postsurgical Pain

From Healing to Hurting: Addressing Sex- and Gender-Based Differences in Chronic Postsurgical Pain

Development and internal validation of a clinical risk tool to predict chronic postsurgical pain in adults: a prospective multicentre cohort study

Abstract Chronic postsurgical pain (CPSP) is a highly prevalent condition. To improve CPSP management, we aimed to develop and internally validate generalizable point-of-care risk tools for preoperative and postoperative prediction of CPSP 3 months after surgery. A multicentre, prospective, cohort study in adult patients undergoing elective surgery was conducted between May 2021 and May 2023. Prediction models were developed for the primary outcome according to the International Association for the Study of Pain criteria and a secondary threshold-based CPSP outcome. Models were developed with multivariable logistic regression and backward stepwise selection. Internal validation was conducted using bootstrap resampling, and optimism was corrected by shrinkage of predictor weights. Model performance was assessed by discrimination and calibration. Clinical utility was assessed by decision curve analysis. The final cohort included 960 patients, 16.3% experienced CPSP according to the primary outcome and 33.6% according to the secondary outcome. The primary CPSP model included age and presence of other preoperative pain. Predictors in the threshold-based models associated with an increased risk of CPSP included younger age, female sex, preoperative pain in the surgical area, other preoperative pain, orthopedic surgery, minimally invasive surgery, expected surgery duration, and acute postsurgical pain intensity. Optimism-corrected area-under-the-receiver-operating curves for preoperative and postoperative threshold-based models were 0.748 and 0.747, respectively. These models demonstrated good calibration and clinical utility. The primary CPSP model demonstrated fair predictive performance including 2 significant predictors. Derivation of a generalizable risk tool with point-of-care predictors was possible for the threshold-based CPSP models but requires independent validation.

Cryoablation in Chronic Pain Management: A Narrative Review

Abstract Cryoneurolysis is a technique of applying extreme cold temperatures to specific sensory nerves, causing a prolonged period of loss of conduction through that nerve. This technique has found widespread application in the field of interventional pain medicine in a variety of conditions including chronic postsurgical pain, phantom limb pain (PLP), and cancer pain. Its use in chronic pain states has been aided further by the advent of handheld cryoneurolysis devices and the widespread use of ultrasonographic imaging to guide and target nerves accurately. Chronic pain states – chronic knee pain from osteoarthritis, refractory PLP, temporomandibular disorders, cervicogenic headaches, low back pain, different peripheral neuropathies, and metastatic bone tumor pain – are some of the conditions where cryoneurolysis has been proven to benefit patients in cases where the symptoms were refractory to other conventionally used modalities. Chronic pain is a complex and multifaceted condition and hence requires a variety of individualized treatment approaches. Current research on this treatment method for chronic pain indicates that it carries low risk and, when used correctly, offers extended pain relief without causing motor function loss. This narrative review includes all types of scientific studies, published between 2010 and 2023, which were selected using a specific set of keywords through two different literature search engines. In conclusion, it explains how cryoneurolysis works to provide long-term pain relief and summarizes the latest evidence supporting its use in chronic pain management.

Risk factors for persistent postoperative opioid use: an entity distinct from chronic postsurgical pain

Despite a decline in opioid prescriptions over the past decade, patients commonly receive opioid analgesics as a treatment for postoperative pain in the USA. One complication that patients may experience...

Comparative Effectiveness of Regional Anesthesia and Nerve Block Techniques in Reducing Chronic Post-Surgical Pain in Adults Undergoing Inguinal Hernia Surgery: A Systematic Review

Background: This study to show about comparative effectiveness of regional anesthesia and nerve block techniques in reducing chronic post-surgical pain in adults undergoing inguinal hernia surgery. Methods: By the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020, this study was able to show that it met all of the requirements. Result: Eight publications were found to be directly related to our ongoing systematic examination after a rigorous three-level screening approach. Subsequently, a comprehensive analysis of the complete text was conducted, and additional scrutiny was given to these articles. Conclusion: CPSP is a multifactorial and complex condition that can significantly affect the quality of life of patients undergoing surgery. General anesthesia plus ilioinguinal nerve block is better than spinal anesthesia (SA) regarding postoperative analgesia, time to mobilization and discharge, side-effect profile and satisfaction experienced by the patients. Regional block anesthesia (RBA) is superior to conventional spinal anesthesia (CSA) for pain relief at 24 hours post-surgery.

The Impact of Regional Anesthesia on Chronic Postsurgical Pain and Persistent Postoperative Opioid Use: Challenges and Opportunities.

The Impact of Regional Anesthesia on Chronic Postsurgical Pain and Persistent Postoperative Opioid Use: Challenges and Opportunities.

Reductions in Chronic Postsurgical Neuropathic Pain and Mechanical Allodynia in Breast Cancer Patients Treated With Laser Acupuncture: A Retrospective Observational Study

IntroductionChronic postsurgical neuropathic pain (CPSNP) and related static mechanical allodynia (SMA) is recognised as a significant long-term complication after breast cancer surgery (BCS). This study investigates the effectiveness of a novel laser acupuncture technique in treating CPSNP and SMA post-BCS whilst patients underwent standard cancer treatments. MethodsThirty patients with significant breast area CPSNP and SMA (DN4 ≥ 4) were treated with 60Milliwatt, 658nm laser acupuncture at Austin Hospital between January 2021 and 2024. Patient data was analysed retrospectively: 29 with CPSNP, 22 with SMA. The cohort had exposures to pain aggravating cancer therapies (e.g. chemotherapy, radiotherapy and antihormonal drugs). An online patient questionnaire assessed treatment outcomes qualitatively. ResultsPatients received an average of 6·4 treatments and their average CPSNP showed significant reduction from 6·86 to 1.29 (P < .001), with a mean 5.57 point decrease (95% CI, 4.90-6.24). Average SMA showed significant reduction from an average of 6.77-1.75 (P < .001), with a mean 5.02-point decrease (95% CI, 4.09-5.96). Pain reductions occurred despite NP aggravating treatment and ongoing usage by 40% of the cohort. 92% of patients reported acute reductions in SMA in the online questionnaire. ConclusionThe significant pain reductions observed may indicate effectiveness of laser acupuncture in reducing both CPSNP and SMA in breast cancer patients post-BCS.