A year after surgery for breast cancer, more than half of all women surveyed reported having persistent pain, and a large proportion of respondents said the pain was moderate or severe. The finding is reported by Finnish investigators in aresearch letter published in the January 1 issue of JAMA.
Of 860 women surveyed, 34.5% reported having no pain 12 months after surgery, 49.7% said they had mild pain, 12.1% reported moderate pain, and 3.7% said their pain was severe.
Factors significantly associated in logistic regression analysis with pain at 1 year were chronic pain before surgery, preoperative pain at the surgical site, preoperative depression, axillary lymph node dissection, chemotherapy, and radiotherapy.
"These findings may be useful in developing strategies for preventing persistent pain following breast cancer treatment. To identify patients who would benefit from preventive interventions, a risk assessment tool is needed," write Tuomo J. Meretoja, MD, PhD, and colleagues from Helsinki University Central Hospital in Finland.
In an emailed response to a question from Medscape Medical News, Dr. Meretoja said that clinicians should evaluate patients for persistent pain according to their history of pain and other factors.
"At the present the best strategy is to look for patients with many of the risk factors found by our study. These patients would probably benefit from more aggressive treatment of postsurgical pain. The patients with severe postoperative pain not responding to conventional pain medication will likely benefit from an acute pain service type of multidisciplinary approach," he wrote.
Factors Associated With Chronic Pain
Dr. Meretoja and colleagues conducted a prospective study to look at the prevalence and severity of pain in women who have undergone surgery for breast cancer and to examine the factors most closely associated with chronic pain in this population.
They surveyed consecutive patients under age 75 who underwent surgery at their institution for unilateral, nonmetastasized breast cancer from 2006 through 2010, excluding patients who received neoadjuvant therapy or breast reconstruction.
Table. Factors Associated With Pain 1 Year After Breast Cancer Surgery (Ordinal Logistic Regression Analysis)
| Factor | P Value |
| Chronic preoperative pain | .04 |
| Axillary surgery | <.001 |
| Chemotherapy | .03 |
| Radiotherapy | <.001 |
| Worst preoperative pain at treatment site | <.001 |
| Beck Depression Inventory score | .003 |
As noted before, they found that about one third of respondents reported having no pain, but approximately half of all patients had mild pain, and about 16% had pain that was moderate or severe on a self-rated pain score.
The authors acknowledged that the study was limited by its reliance on self-report rather than on clinical evaluations of the type of persistent pain.
The study was supported by grants from the Academy of Finland and Helsinki and Uusimaa Hospital District, and by funding from the Orion-Pharmos Research Foundation and Emil Aaltonen Foundation. Dr. Meretoja has disclosed no relevant financial relationships. A coauthor reported receiving research support and speaking fees from and owning stock in Orion Pharma.
JAMA. 2014;311:90-92. Abstract
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