Pain In Breast Cancer Patients Research Articles

Proposing and evaluating a model of depression, stress, resilience and spirituality in relation to pain in women with breast cancer: Investigating the mediating role of mindfulness

Pain experience is one of the most common symptoms of women with breast cancer receiving chemotherapy. It may cause physical and psychological problems and interfere with the treatment process. This study aimed to examine the relationship between depression, stress, resilience and spirituality on the pain symptoms of breast cancer patients during chemotherapy and explore the potential mediating role of mindfulness in this association. Two hundred and forty women with breast cancer receiving chemotherapy from Shiraz University Hospital, were selected and evaluated by a purposive sampling method. The research instruments were Perceived Stress Scale, Beck Depression Questionnaire-2, Mindfulness, Resilience, Spirituality and Pain Questionnaires. The obtained data was analyzed by SPSS software and MPLUS using Spearman correlation coefficient and path analysis. Based on the findings of direct path analysis, depression, stress, and spirituality showed a significant relationship with mindfulness, but resilience had no significant relationship with mindfulness (p<0.01). Furthermore, depression, stress, resilience, and mindfulness showed a significant relationship with pain, while spirituality had no significant relationship with pain (p<0.01). Finally, indirect path analysis revealed mindfulness is a significant mediator of stress and pain (p<0.05). The present study suggested a model can be useful in better understanding of the psychological components affecting pain in breast cancer patients, after and during their treatments. It also provided an effective framework to develop and investigate pain-focused and non-pharmacological interventions.

HUBUNGAN TINDAKAN KEMOTERAPI DENGAN KEJADIAN NYERI OTOT PADA PASIEN KANKER PAYUDARA DI RSU SEMBIRING

Breast cancer is an abnormal cell division in the breast that cannot be controlled so that it spreads quickly. Pain is a factor that contributes to the emergence of fatigue in cancer patients, and has the potential for treatment. Chronic pain is a major healthcare problem for patients with cancer and a major treatment for cancer. Patients will often feel pain during illness or after following chemotherapy. This study aims to determine the relationship between chemotherapy actions and the incidence of muscle pain in breast cancer patients at Sembiring Deli Tua Hospital in 2022. This study used quantitative correlation using a cross sectional approach, the number of samples in this study was 30 people with total side technique. , data collection using research instruments, for independent variables using medical records, and the dependent variable using a Numeric Rating Scale (NRS) questionnaire and observation sheets. The results showed that from 30 respondents. Based on the results of statistical test analysis using the Chi square test with a p-value of 0.028, the p value &lt;0.05. These results indicate that Ha is accepted. Thus, it can be concluded that there is a significant relationship between chemotherapy action and the incidence of muscle pain in breast cancer patients at Sembiring General Hospital Deli Tua in 2022.

Chronic pain in breast cancer patients post mastectomy with alloplastic reconstruction: A scoping review.

Women diagnosed with breast cancer are receiving mastectomy with implant-based reconstruction at an increasing rate. Chronic post-surgical pain can be a major concern for these patients. This review sought to address the knowledge gap on the prevalence, severity and characteristics of chronic pain in this population. A scoping review was conducted using the Arksey and O'Malley framework. Five databases were searched using keywords. Two independent reviewers performed selection and data extraction of studies that met inclusion criteria. Seventeen studies were included in this review. Ten studies reported prevalence of chronic pain which ranged from 7.3%-90.9% with pooled prevalence of 26.3%. Nine studies reported severity of chronic pain using various scales and methodology; most patients' pain was not severe. Risk factors for chronic pain included axillary dissection, lack of perioperative local anaesthetic, younger age and use of a tissue expander. No studies reported on possible correlation between ethnicity and pain. Eleven different assessment tools were used to measure pain. Chronic pain following post-mastectomy implant-based breast reconstruction is prevalent, associated with specific risk factors and poorly characterised. There is a need to investigate and evaluate chronic pain in this population using validated breast cancer specific pain assessment tools.

Osteopathy as a complementary/alternative medicine for breast cancer: a Canadian case study and comprehensive review

Aim: In Canada, osteopathic medicine, a well-known branch of complementary/alternative medicine, has received minimal attention for pain management within oncology. Purpose: This review reports both the existing literature and patient experience surrounding the application of osteopathy as an effective treatment for pain in breast cancer patients. Results: Both the literature and this case study support, to some degree, the benefits of osteopathy as pain management for breast cancer patients. Conclusion: Due to contradictory reported findings, more studies would be required to make firm conclusions, especially within a Canadian context. However, a lack of standardization of osteopathic procedures and collaboration between osteopaths and traditional healthcare professionals are challenges in including osteopathy as a standard service offered to breast cancer patients.

Penggunaan Pijat Refleksi untuk Mengurangi Nyeri pada Pasien Kanker Payudara

This study aims to review the effectiveness of reflexology on pain reduction in breast cancer patients. The research method used is writing a systematic review using search results of scientific publications published between 2016 and 2021 through international electronic databases such as PubMed, ProQuest, CINAHL, and Cochrane, which then follows PRISMA guidelines and research questions using PICO. The results showed that eight articles from the search contained six RCT articles and two cohort articles than in each piece provided the same intervention, namely reflexology intervention to reduce pain in breast cancer patients which later resulted in reduced pain felt by breast cancer patients. . In conclusion, all articles show the effectiveness of reflexology to reduce pain in breast cancer patients.&#x0D;  &#x0D; Keywords: Breast Cancer, Pain, Reflexology

Abstract P5-18-01: Mechanistic evidence associated with the benefit of plinabulin significantly reducing Bone pain in breast cancer patients (pts) treated with TAC (docetaxel, doxorubicin, cyclophosphamide) and pegfilgrastim (Peg)

Abstract Introduction Bone pain is a debilitating adverse reaction associated with G-CSF (including Peg) in Breast Cancer (BC) pts receiving chemotherapy (Chemo). G-CSF shortens the time to, duration of, and depth of the neutrophil (ANC) nadir, associated with an acceleration of hematopoietic stem cell differentiation into mature neutrophils (Crawford NEJM 1991). We hypothesized that this acceleration is accompanied by an expansion of bone intramedullary contents (including hematopoietic precursors) and can lead to an increase in intra-cavitary pressure and stimulation of intra-osseous Aδ mechano-nociceptors, which are transmitted as pain sensations through Piezo2 signaling to the brain (Nencini and Ivanusic, 2017; Oostinga Bone 2020). Plinabulin (Plin) is a novel, non-G-CSF, small molecule agent with anticancer activity, that also prevents chemotherapy-induced neutropenia (CIN). Plin has a fast onset mechanism of action (MoA) for CIN-prevention acting in the first week of the cycle, whereas Peg has a slow MoA, acting in the second week of the cycle. Combining Plin+Peg resulted in superior CIN prevention, significantly higher ANC nadir and significantly less bone pain (Blayney ASCO 2020; St Gallen 2019). Method Data from the randomized, double-blinded trial PROTECTIVE-2 (NCT0329457) evaluating CIN outcomes with the Plin+Peg combination (n=111) vs Peg alone (n=110) in BC pts receiving TAC were analyzed for timing of bone pain occurrence relative to ANC Nadir, and whether maximum bone pain score was correlated (inversely) with ANC nadir. Patient reported outcome (PRO) bone pain scores were from validated Numerical Rate Scale (NRS)-based questionnaires. Bone AEs were obtained from case report forms. ANC Nadir was evaluated from central laboratory (COVANCE) assessments of almost daily ANC assessments. Results ANC declined rapidly between Day 3 and Day 7 (the time point of ANC nadir in both groups) and significantly steeper with Peg vs Peg+Plin (P&amp;lt;0.013). ANC nadir reached lower levels with Peg vs Plin+Peg: 0.32 vs 0.54 x10E9/L (p=0.0002). Peak bone pain score (NRS method) occurred around Day 5 and was significantly (P&amp;lt;0.05) higher for Peg vs Plin+ Peg Bone pain score (NRS) plotted against the absolute neutrophil count at time of nadir, demonstrated and inverse and statistically significant correlation (p=0.019). The Peg alone group had significantly higher bone pain AE frequency over 4 cycles vs Plin+Peg (30% vs 18%; p=0.03). Conclusion The collective data supports the concept that bone pain in pts receiving myelosuppressive chemotherapy and Peg is a direct consequence of accelerated drop in ANC and to deeper levels by Peg, triggering an accelerated intramedullary compensatory hematopoietic response and associate pressure build up that sensed as bone pain. The addition of Plin to Peg slowed down the Peg-induced speed and deepening of ANC decline, and consequently ameliorates this intramedullary response mechanism and bone pain generation. Citation Format: Douglas W. Blayney, Stephan Ogenstad, Mengru Chang, Yvette Lelorier, Lan Huang, Ramon Mohanlal. Mechanistic evidence associated with the benefit of plinabulin significantly reducing Bone pain in breast cancer patients (pts) treated with TAC (docetaxel, doxorubicin, cyclophosphamide) and pegfilgrastim (Peg) [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P5-18-01.

Association between aesthetic satisfaction and chronic postsurgical pain in breast cancer patients treated with one stage prosthesis implantation

This study retrospectively studied the incidence of chronic post-surgical pain (CPSP) following single-stage implant-based breast reconstruction (IBBR) and evaluated the possible risk factors. This was a retrospective cohort study, involving all patients undergoing single-stage IBBR between January and December 2019. The follow-up was completed between January and March 2021. The scores for satisfaction (SS) were based on the BREAST-Q, while the pain burden index (PBI) was used to assess the degree of CPSP. The questionnaires were completed by 159 patients. CPSP occurred in 48.43% of the patients, 2.52% of them being severe cases. Significant predictors for the development of CPSP in the univariate analysis included severe acute postoperative pain (PP), a history of preoperative chronic pain, psychological disorders, SS with the reconstructed breasts, and whether there were any regrets about having had the reconstruction. Multivariate analysis identified severe acute PP (odds ratio (OR) = 2.80, 95% confidence interval (CI) = 1.16–6.79, p = 0.023), a history of preoperative chronic pain (OR = 3.39, 95% CI = 1.42–8.10, p = 0.006), and the SS (OR = 0.86, 95% CI = 0.75–0.99, p = 0.034) as being independently associated with the development of CPSP. In subgroup analysis, the PBI of the patients in the SS < 12 group (p < 0.001), the bilateral group (p < 0.01), and the severe acute PP group (p < 0.005) was significantly higher than the PBI of those in the control groups. This study demonstrated a significant incidence of CPSP following single-stage IBBR, and the patients with lower SS of their reconstructed breasts developed more CPSP. Lower SS, bilateral procedures, and severe acute PP were predictors of higher PBI.Trial registration: Registered in Chictr.org.cn registry system on 24 February 2020 (ChiCTR2000030139).

Postoperative analgesic effect of parecoxib sodium local anesthesia in patients with breast cancer through systematic review and meta-analysis.

Postoperative pain can seriously affect a patient's recovery, and parecoxib sodium has a good analgesic effect. However, there is a lack of clinically systematic analyses of the effects of parecoxib sodium on postoperative pain in breast cancer patients. The aim of the present study was to systematically evaluate the efficacy and safety of parecoxib sodium local anesthesia in the treatment of postoperative pain in breast cancer patients. Literature published from January 2010 to December 2020 was searched in the China National Knowledge Infrastructure database, Wanfang database, PubMed, and Cochrane Library. Literature on randomized controlled trials of parecoxib sodium local anesthesia in patients with breast cancer was collected. Method of treatment was extracted and literature quality was assessed. Meta-analyses of included literature were performed using RevMan 5.3. A total of 17 randomized controlled trials were included, with a total of 1,032 breast cancer surgery patients. The experimental group was treated with parecoxib sodium anesthesia, and the control group was treated with other anesthesia methods. The meta-analysis results showed that there were obvious differences among visual analogue scale (VAS) score of the experimental group and control group 2 h after surgery [mean difference (MD): -0.79; 95% confidence interval (CI): -1.29 to -0.29; P=0.002], 4 h (MD =-0.77; 95% CI: =-1.51 to -0.03; P=0.04), 6 h (MD: -1.10; 95% CI: -1.41 to -0.80; P<0.00001), 8 h (MD: -0.66; 95% CI: -1.00 to -0.33; P=0.0001), 12 h (MD: -0.92; 95% CI: -1.24 to -0.60; P<0.00001), 24 h (MD: -0.86; 95% CI: -1.15 to -0.58; P<0.00001), and 48 h (MD: -0.90; 95% CI: -1.47 to -0.33; P=0.002). Moreover, visual analog scale score and the postoperative controlled analgesia frequency of patients in the experimental group (MD: -2.08; 95% CI: -2.88 to -1.27; P<0.00001) and the incidence of adverse reactions (odds ratio: 0.52; 95% CI: 0.34-0.80; P=0.002) were significantly reduced. Parecoxib sodium local anesthesia for breast cancer patients has good postoperative analgesia and treatment safety.

Pain Management in Breast Cancer Patients: A Multidisciplinary Approach.

Pain is a significant problem and is one of the most invalidating symptoms in breast cancer (BC) patients that would negatively affect the functional status and the Quality of Life (QoL). Pain management in BC patients requires thorough patient evaluation and critical assessment of pain. The actual cause for the pain must be recognized, so management can be tailored to each patient. This review aims to discuss various treatment modalities employed for effectively managing pain in BC patients.Pharmacotherapy makes up the cornerstone of the management of pain in BC patients. Both opioid and non-opioid analgesics are utilized. The WHO recommends a method called “by the ladder” for managing pain in BC patients where analgesics are used in ascending order. In comprehensive pain management (CPM), non-pharmacologic therapies are gaining wide acceptance and popularity, including complementary and alternative medicine (CAM), procedural and psychosocial interventions. Procedural interventions are usually used in case of severe pain refractory to pharmacological therapy. Techniques, such as radiotherapy, neurectomy, and nerve blocks, are effective in managing cancer pain. However, CAM therapies in BC pain management need to be guided by enough scientific evidence, decision-making, and medical judgment of regulatory bodies.BC pain management is based on careful routine pain assessments and appropriate patient evaluation both physically and psychologically. Pain control is one of the methods to improve the QoL of BC patients. Both pharmacological and non-pharmacological therapies are accessible to patients today, but they should be used with caution to minimize toxicity and increase effectiveness. The use of any pain management intervention should be based on proper scientific evidence and collective medical judgment.

Association of OPRM1, MIR23B, and MIR107 genetic variability with acute and chronic pain after postoperative tramadol treatment in breast cancer.

e24052 Background: Tramadol is an opioid analgesic often used for pain management after axillary lymph node dissection in breast cancer. It exerts its analgesic activity through activation of the G protein-coupled µ-opioid receptor, encoded by the OPRM1 gene. Genetic factors that may modify activity or expression of OPRM1 could thus affect the efficacy of tramadol treatment. This study investigated the association of genetic variability of OPRM1 and genes coding for miRNAs regulating OPRM1 expression with pain management in breast cancer patients treated with tramadol after surgery. Methods: The study included 113 breast cancer patients treated with either 75 or 37.5 mg of tramadol for pain relief after breast cancer surgery within the randomized clinical trial KCT 04/2015-DORETAonko/si at Institute of Oncology Ljubljana. All patients were genotyped for OPRM1 rs1799971 and rs677830, MIR23B rs1011784 and MIR107 rs2296616 using competitive allele-specific PCR. The association of genetic factors with acute and chronic pain was evaluated using logistic regression, Fisher’s exact test and Mann-Whitney test. Results: The investigated OPRM1 related genetic factors were not associated with acute pain measured using VAS scale within four weeks after surgery, even after adjustment for tramadol dose (all P &gt; 0.05). One year after surgery, 21 (21.1%) patients experienced chronic pain and 25 (25.3%) experienced neuropathic pain. In carriers of two polymorphic MIR107 rs2296616 alleles, chronic pain was significantly more common compared to carriers of two wild-type alleles (35.3% compared to 0% of patients, P = 0.004). Carriers of at least one polymorphic MIR23B rs1011784 allele experienced more neuropathic pain compared to carriers of two wild-type alleles after adjustment for tramadol dose (OR = 2.85, 95% CI = 1.07-7.59, P = 0.036). Conclusions: Genetic variability of miRNAs that could affect OPRM1 expression may be associated with chronic pain in breast cancer patients treated with postoperative tramadol.

Taxane-induced pain in breast cancer patients as perceived by nurses

Introduction Treatment with taxane-containing chemotherapy regimens is crucial for improving survival in patients with early-stage invasive breast cancer. Recent literature describes a high incidence of taxane-induced neuropathic pain or/and muscle and joint pain. For patients, oncology nurses can play an integral role as a resource for pain control. There is a knowledge gap regarding how nurses perceive patients’ experienced taxane-induced pain and support from their organizations when caring for patients with such pain. Aim Investigate nurses’ perceptions of occurrence of taxane-induced pain and identify organizational support for managing such pain. Material and methods A cross-sectional observation study, conducted in 2017–2018, with a web-based questionnaire to 240 nurses working at oncology outpatient units in Sweden. The areas of concern were start-decline, duration, prevalence, intensity, and bodily distribution of taxane-induced pain. Patient information, guidelines, prophylactic analgesia, and perceived support were used to counteract such pain. Data were analyzed using descriptive statistics and a logistic regression model to estimate associations. Results One hundred sixty-one nurses completed the questionnaire, describing their perceptions of taxane-induced pain in patients with breast cancer. The prevalence and intensity of taxane-induced pain were experienced as divergent. Some consensus was found among the nurses regarding the start of the pain, but not when declined. The body areas where pain was expected to occur were the muscles, joints, legs, feet, and mainly the back of the trunk. Low use of local/national guidelines for managing taxane-induced pain was described. No relationship was found between factors related to the nurses’ characteristics (age, work experience in oncology care, or specialist education in oncology) that significantly affected their perceptions regarding the occurrence of taxane-induced pain or pain intensity. Conclusion: This study highlights a need for attention to education and guidelines for how to observe, treat, and evaluate this particular type of pain.

Pengaruh Guided Imagery Terhadap Skala Nyeri Pada Pasien Kanker Payudara Di Ruangan Rawat Inap Bedah Wanita RSUP Dr. M.Djamil Padang

ABSTRACTBreast cancer is the abnormal growth of cells that occurs in breast tissue. The problem often arises in patients with breast cancer is pain. Guided Imagery is a nonpharmacological strategi that can reduce pain. The aimed of this research was to identify the effect of Guided Imagery to the scale of pain in breast cancer patients admited in female surgical wards Dr. M. Djamil hospital Padang. The study design was quasi experimental using pretest-posttest with control group and using a consecutive sampling. The number of samples was 30 people (15 control group and 15 the intervention group). Pain was measured by the Numeric Rating Scale (NRS). The statistical test was two different test mean. The result was a significant effect on the pain scale Guided Imagery in breast cancer patients (P Value = 0.000; α = 0.05). There was a significant relationship between the age with the pain scale (P Value = 0.000; α = 0.05), and there is no relationship between the tribe with the pain scale. The results of this study recommends Guided Imagery being implemented as nursing interventions to reduce the pain of breast cancer.

Relationships of sleep disturbance, intestinal microbiota, and postoperative pain in breast cancer patients: a prospective observational study

PurposeOur study was designed to examine the possible relationship between gut microbiota, sleep disturbances, and acute postoperative pain.MethodsUsing 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.ResultsPreoperative 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).ConclusionThese 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 registrationThe 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.

Thoracic Paravertebral Blockade Reduces Chronic Postsurgical Pain in Breast Cancer Patients: A Randomized Controlled Trial.

ObjectiveTo evaluate the effect of multilevel single-shot thoracic paravertebral blockade (PVB) on the occurrence of chronic postsurgical pain (CPSP) in patients undergoing breast cancer surgery.DesignA randomized controlled trial with two parallel groups.SettingA tertiary hospital.MethodsPatients scheduled for breast cancer surgery were randomized to receive either ultrasound-guided multilevel single-shot PVB from T2 to T5 (the PVB group) or nothing (the control group). Surgery was then performed under general anesthesia. Patients were followed up for 12 months after surgery. The primary end point was incidence of CPSP at six months after surgery.ResultsA total of 218 patients were enrolled and randomized; of these, 208 and 204 completed six- and 12-month follow-up, respectively. The incidence of CPSP at six months was significantly lower in the PVB group (12.5% [13/104]) than in the control group (24.0% [25/104], relative risk = 0.52, 95% CI = 0.28–0.96, P = 0.031). Pain scores within 48 hours both at rest and with movement were lower in the PVB group than the control group (P = 0.006 and P < 0.001, respectively). The percentages of patients with neuropathic pain were also lower in the PVB group than the control group at both six and 12 months after surgery (P = 0.016 and 0.028, respectively). Adverse events did not differ between groups.ConclusionsFor patients undergoing breast cancer surgery, multilevel single-shot PVB reduces the incidence of CPSP at six months; it also improves early postoperative analgesia and reduces neuropathic pain at six and 12 months after surgery.

The Effects of Oral Cryotherapy on Nausea, Vomiting, Oral Mucositis, and Oral Pain in Breast Cancer Patients Undergoing Chemotherapy

The Effects of Oral Cryotherapy on Nausea, Vomiting, Oral Mucositis, and Oral Pain in Breast Cancer Patients Undergoing Chemotherapy

Study of pregabalin effect on postsurgical pain in breast cancer patients: A double-blind randomized clinical trial using placebo.

Study of pregabalin effect on postsurgical pain in breast cancer patients: A double-blind randomized clinical trial using placebo.

Pengaruh Kombinasi Terapi Musik Dan Art Therapy Terhadap Tingkat Nyeri Pasien Kanker Payudara

Background : Cancer pain is a multidimensional experience of cancer patients that can affect all dimensions of the quality of life of patients. The capacity of one's attention to a condition is very limited, therefore to reduce the capacity of the process of pain required distraction or input of a strong stimulus that is fun, one of them with a combination of art therapy and music therapy. Objective : This study aims to determine the effect of a combination of music therapy and art therapy to the level of pain in breast cancer patients. Methode : This study uses quasi-experimental design involving 34 respondents selected by purposive sampling. Results : The results of this study indicate that there are significant differences in the level of pain after treatment between groups who only received standard analgesic and groups who received a combination of music therapy and art therapy with p-value = 0.008 (p &lt;0.05). Based on the results of the study, it can be concluded that the combination of music therapy and art therapy is more effective for reducing pain in people living with breast cancer than only standard analgesic. Conclusion : The results of this study can be one of the intervention recommendations to reduce pain in breast cancer sufferers and encourage independence in the autonomy role of nurses.Keywords: art therapy, pain, breast cancer

Incidence of breast pain in breast cancer patients in a multi-ethnic cohort.

e24085 Background: Breast cancer is the most common cancer in women. Prevalence rates for persistent pain following breast cancer surgery are reported to be up to 60%. Younger age, radiation, more invasive surgery, and acute post-operative pain have been identified as predictors of chronic pain after surgery. Several studies have looked at factors predicting breast pain, but to our knowledge none of these studies have reported on perceived pain among ethnic groups beyond white and non-white comparisons. Methods: Participants were asked to complete an anonymous breast pain questionnaire based on the McGill pain questionnaire, either online or face-to-face in a clinical setting. Incidence and type of breast pain, common risk factors (age, type of surgery, treatment: chemotherapy, radiation and endocrine therapy), and race/ethnicity was collected and analyzed through descriptive and multivariate analysis. Results: 238 responses were collected and analyzed. About 36% of participants reported breast pain, where 82% reported these symptoms for more than a year. More than 71% identified as non-white, with the majority identifying as Asian (50%) followed by White (11%), Multi-ethnic (9%) and Native Hawaiian (8%). The majority of participants were older than 60 years of age (57%), with 30% being older than 70. Japanese, Filipino and Native Hawaiian participants reported significantly more pain compared to White participants (p &lt; .0001). The majority of participants reported a 3/10 pain level on a pain scale and described overall breast pain as mild. The most common descriptor of mild pain was aching and represents the dullness pain characteristic. The most common descriptor of moderate pain was sharp characterizing an incisive pressure, and the most common descriptors of severe pain were heavy, tender, shooting and throbbing, representing various pain characteristics. Participants who were undergoing radiation (p &lt; .0001) or chemotherapy (p &lt; .05) reported statistically higher breast pain, although there were no differences in breast pain according to the type of surgery (mastectomy vs lumpectomy). Participants who completed the survey online also reported more pain (p &lt; .0001) than participants who completed the survey face-to-face. Conclusions: Breast pain is a significant problem in our breast cancer community. This questionnaire has informed our understanding of the type of pain our multi-ethnic breast cancer patients are experiencing and in turn we are developing culturally appropriate pain management strategies to treat this challenging symptom for breast cancer survivors.

Self-reported pain in breast cancer patients receiving adjuvant radiotherapy.

Breast cancer patients receiving radiotherapy (RT) commonly report pain, contributing to physical and emotional distress, and potentially resulting in poor quality of life. This study prospectively identified trends and risk factors in patient-reported pain associated with breast irradiation using the Edmonton Symptom Assessment Scale (ESAS) and a study-specific Skin Symptom Assessment (SSA). Before RT and once per week during RT, patients completed the ESAS and SSA. Upon RT completion, patients were contacted via telephone to complete both assessments weekly for 6weeks, and a final assessment was conducted 1-3months post-RT. Only data from patients who had completed both assessments before, at least once during, and at least once after RT were included in our analysis. A total of 426 patients provided data for the analysis. Overall acute pain increased significantly at week 1-2 (p < 0.0001), week 5 (p = 0.0011), and at 1-3months (p < 0.0001) post-RT compared with baseline, and acute breast pain increased significantly at week 1 (p < 0.001) and week 2 (p = 0.0002) post-RT compared with baseline. Previous chemotherapy (adjuvant or neoadjuvant) in mastectomy patients was associated with increased overall pain compared with mastectomy patients without previous chemotherapy (p = 0.017). Younger patients (40-49 or 50-59years of age) reported more overall pain (p = 0.0001, p = 0.038) and breast pain (p = 0.0003, p = 0.0038) compared with patients ≥ 60years of age. Patient-reported pain associated with breast irradiation peaked 1week after RT completion. Our findings provide support for closer monitoring of acute pain associated with breast RT in younger patients.

Unveiling the Impact of Morphine on Tamoxifen Metabolism in Mice in vivo.

Background: Tamoxifen is used to treat breast cancer and cancer recurrences. After administration, tamoxifen is converted into two more potent antitumor compounds, 4OH-tamoxifen and endoxifen by the CYP3A4/5 and 2D6 enzymes in human. These active compounds are inactivated by the same UDP-glucuronosyltransferase isoforms as those involved in the metabolism of morphine. Importantly, cancer-associated pain can be treated with morphine, and the common metabolic pathway of morphine and tamoxifen suggests potential clinically relevant interactions.Methods: Mouse liver microsomes were used to determine the impact of morphine on 4OH-tamoxifen metabolism in vitro. For in vivo experiments, female mice were first injected with tamoxifen alone and then with tamoxifen and morphine. Blood was collected, and LC-MS/MS was used to quantify tamoxifen, 4OH-tamoxifen, N-desmethyltamoxifen, endoxifen, 4OH-tamoxifen-glucuronide, and endoxifen-glucuronide.Results: In vitro, we found increased Km values for the production of 4OH-tamoxifen-glucuronide in the presence of morphine, suggesting an inhibitory effect on 4OH-tamoxifen glucuronidation. Conversely, in vivo morphine treatment decreased 4OH-tamoxifen levels in the blood while dramatically increasing the formation of inactive metabolites 4OH-tamoxifen-glucuronide and endoxifen-glucuronide.Conclusions: Our findings emphasize the need for caution when extrapolating results from in vitro metabolic assays to in vivo drug metabolism interactions. Importantly, morphine strongly impacts tamoxifen metabolism in mice. It suggests that tamoxifen efficiency could be reduced when both drugs are co-administered in a clinical setting, e.g., to relieve pain in breast cancer patients. Further studies are needed to assess the potential for tamoxifen-morphine metabolic interactions in humans.