Factors Associated With Pain After Breast Cancer Surgery

Many women have prolonged pain following breast cancer surgery. Identifying factors linked to this longer-term pain after surgery may facilitate treatment and prevention methods. Researchers at the Helsinki University Central Hospital in Finland studied these factors-including the prevalence and severity associated with both surgery and adjuvant treatment for breast cancer-and found that almost 50% of patients in the trial had mild pain 1 year after surgery and 15.8% had moderate or severe pain. The study is published in JAMA.

The factors significantly associated with pain 1 year after surgery included chronic preoperative pain, preoperative pain in the area to be operated, preoperative depression, axillary lymph node dissection, chemotherapy, and radiotherapy.

“I believe the most important result here was just how common persistent pain is after 12 months from breast cancer surgery,” Tuomo Meretoja, MD, PhD, of the breast surgery unit at the Helsinki University Central Hospital, told Cancer Network. “Luckily most of the patients with persistent pain only have mild pains and the most severe and hardest-to-treat persistent pains are much less frequent.”

This initial study may be used to develop strategies for preventing chronic pain in breast cancer surgery patients, stated the authors, who also suggest that a risk assessment tool is needed to identify patients who may benefit from preventive interventions.

At 1 year, 3.7% of patients reported severe pain, 34.5% reported no pain, 49.7% had mild pain, and 12.1% had moderate pain.

A total of 860 women under the age of 75 with non-metastatic breast cancer who were treated at the Helsinki University Central Hospital between 2006 and 2010 were enrolled in the trial. Women were sent a questionnaire 12 months after surgery.

Twenty-four percent of the women had chronic pain prior to surgery. The majority (62%) had a resection while 38% had a mastectomy. Seventy-five percent were over the age of 50. The mean age was 57 years.

Follow-up of this study is ongoing and further results are likely to be reported in the future.

“We hope to develop a risk assessment tool on the basis of the current study in order to recognize patients at risk of developing persistent pain,” said Meretoja.