Constant pain after breast cancer surgery ‘more taxing’

By Piriya Mahendra

Women who experience chronic pain after treatment for breast cancer are not significantly more anxious or depressed than women without pain, find researchers.

However, patients whose chronic pain after breast cancer treatment is persistent are significantly more anxious than those whose pain is intermittent, report David Sheridan (Western General Hospital, Edinburgh, UK) and team.

The persistence and prevalence of chronic pain in patients who have been treated for breast cancer suggests that long-term follow-up patients should regularly be asked about any painful symptoms they have. "More patients could then be referred to pain specialists for treatment," remark the authors in the Journal of Pain and Symptom Management.

They found that of the 111 patients studied, 33 (29.7%) reported chronic pain at a median of 64 months postoperatively.

Exercise exacerbated pain in 32.1% of patients. Exacerbations were also reported in relation to dressing (21.4%), lifting (7.1%), writing (3.6%), using the phone (3.6%), and other factors (21.4%). Overall, 42.9% of patients reported that nothing exacerbated their pain.

Patients were asked whether their pain was intermittent. Of the 30 who responded to this question, seven (23.3%) said their pain was constant and three (76.7%) said the pain came and went.

The Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) was completed by 25 (76%) of 33 patients who reported chronic pain. Of these, 10 (40%) achieved a score of 12 or more, indicating that their pain was likely to be neuropathic; four patients scored 11 and were borderline.

Logistic regression analysis revealed that chemotherapy increased the risk for developing chronic pain after breast cancer treatment threefold. "This finding is supported by the large body of previous literature showing that chemotherapy is a risk factor for peripheral neuropathic pain," comment Sheridan et al.

Preoperative pain was also shown to confer a fivefold increased risk for developing chronic pain.

The authors remark that the lack of an association between anxiety/depression and persistent pain after breast cancer treatment "may partly explain why only a small number of patients wanted to consult a physician and is supported by recent research."

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