About half of women who have breast cancer surgery have continuing pain problems a year or more after surgery, according to the study reviewed here.
The researchers asked nearly 4,000 women age 18 to 70 who had had surgery to remove early-stage breast cancer about any pain problems they had had since the surgery. The women completed the questionnaire about 2 years after surgery, on average.
Overall, 47% of the women said they had recurring pain somewhere in their bodies:
Pain was more likely in women who:
Surprisingly, only about 25% of the women with chronic pain after breast cancer surgery talked to a doctor about treating the pain or tried to treat it on their own:
Treatment side effects, including pain, are a problem for many women diagnosed with breast cancer. There are a number of reasons why someone might have continuing pain after surgery, including unavoidable tissue and nerve damage when the cancer and any lymph nodes are removed. Lymphedema, a swelling of the arm, hand, or chest wall caused by a build-up of lymph fluid in those tissues after breast cancer surgery, also can be painful. But you don't have to suffer. With proper treatment, most people can get relief from most, if not all, of their pain.
Pain medications have become increasingly sophisticated and effective. There are more ways for you to take them, new knowledge of how to use them, and fewer side effects. Today, we also understand more about how complementary and holistic therapies, such as acupuncture, Reiki, and massage -- which don't use medication -- may help reduce or end pain.
If you're worried about pain during and after breast cancer treatment or have pain months after treatment, don't suffer in silence. Talk to your doctor. You may want to ask for a referral to a pain specialist who can help develop a treatment plan for your specific pain and situation.
You can learn much more about treatment-related pain and approaches to managing that pain in the Breastcancer.org Pain section.
Nearly half of breast cancer survivors are plagued by persistent pain years after cancer surgery, researchers found.
Pain two to three years later was most common for younger women and those who had axillary lymph node dissection, Rune Gärtner, MD, of the University of Copenhagen, and colleagues reported.
Their population-based study appeared in the Nov. 11 issue of the Journal of the American Medical Association.
While prior, largely retrospective and single-center studies have also supported a chronic pain rate of about 50% after breast cancer resection, identifying high-risk patients is an important advance, according to an accompanying editorial.
Loretta S. Loftus, MD, MBA, and Christine Laronga, MD, both of the H. Lee Moffitt Cancer Center in Tampa, Fla., wrote that recognizing the predictors may help doctors start therapy earlier.
"Management requires a multidisciplinary approach that includes evaluation by surgeons, medical oncologists, radiation oncologists, pain management specialists, psychologists and psychiatrists, social workers, and experts in rehabilitation medicine," they said.
Although sentinel node dissection has reduced pain complaints after surgery, attention should focus on nerve-sparing techniques in particular, Gärtner's group added.
Postsurgical pain can stem from nerve damage during the operation that results in intercostobrachial neuralgia, neuroma pain, or phantom breast pain (MedPage Today) -- or from compression injury to the brachial plexus due to lymphedema, or even from a second primary tumor, the editorialists noted.
Gärtner's group conducted a prospective, cross-sectional study of all Danish women who received surgery and adjuvant therapy, if indicated, from 2005 through 2006.
The 3,754 women ages 18 to 70 years responded to the study questionnaire an average of 26 months (range 13 to 41 months) after surgery. None had reported a breast cancer recurrence or other malignancy since initial treatment.
Overall, 47% of the patients reported pain in at least one area of their body.
Among them, 13% had severe pain, with a score of at least 8 on the 10-point scale. For them, daily pain was the norm (77%).
Another 39% of women who reported pain said it was of moderate severity with a score of 4 to 7 points on the same scale. But overall, only about a quarter of the women with pain sought any treatment for it:
The most common site of pain was the breast area (86%), followed by the axilla (63%), arm (57%), and side of the body (56%).
Factors that predicted persistent pain were:
Sensory disturbances -- such as allodynia, aftersensations, burning, or sensory loss -- also appeared linked to chronic pain.
While 58% of the women reported sensory disturbances or discomfort overall, 65% reported pain as well, while only 23% of women reported pain without sensory disturbances (P<0.001).
Women under 40 were again at highest risk for sensory disturbances (OR 5.00 to 6.06 versus ages 60 to 69, depending on type of surgery, all P<0.001).
Axillary lymph node dissection was, likewise, again associated with increased risk compared with sentinel lymph node dissection (OR 4.97, P<0.001).
The researchers noted that the study included few women on aromatase inhibitor treatment, which is known to cause muscular and joint pain.
Also, further study is needed to determine how pain and sensory disturbances will develop or ease over time because the Danish study included only a single point, they noted.
The results may be of limited generalizability to other healthcare systems and to populations that are more ethnically, racially, and socioeconomically diverse, but the study still provides a plausible estimate, the editorialists wrote.
The study was supported by grants from the Danish Cancer Society, Breast Friends, and the Lundbeck Foundation. The grants exclusively covered salaries. The researchers reported no conflicts of interests. Loftus and Laronga reported no conflicts of interest.
Primary source: Journal of the American Medical Association Source reference: Gärtner R, et al "Prevalence of and factors associated with persistent pain following breast cancer surgery" JAMA 2009; 302: 1985-92.Additional source: Journal of the American Medical AssociationSource reference: Loftus LS, Laronga C "Evaluating patients with chronic pain after breast cancer surgery: The search for relief" JAMA 2009; 302: 2034-35.
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