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Persistent Pain Common for Many Women 2 to 3 Years After Breast Cancer Treatment CHICAGO -- November 10, 2009 -- Nearly 50% of women surveyed indicate they experience pain symptoms 2 to 3 years after breast cancer treatment, with women who were younger or who received supplemental radiation therapy more likely to have pain, according to a study published in the November 11 issue of JAMA. Persistent postsurgical pain has been shown to be clinically relevant in many patients undergoing various common operations, including breast cancer surgery. With breast cancer, the pathogenic mechanisms are multiple, including nerve damage related to surgical technique, according to background information in the article. Different types of sensory disturbances (e.g., aftersensations, burning, or sensory loss) can occur after other surgical procedures and may be an important part of the pain characteristics in breast cancer. “Pain has also been reported to be associated with adjuvant therapy, such as chemotherapy and radiotherapy,” the authors wrote. Rune Gärtner, MD, University of Copenhagen, Copenhagen, Denmark, and colleagues examined the prevalence, associated factors, and severity of chronic pain and sensory disturbances an average of 26 months after surgery for breast cancer of 3,754 women, aged 18 to 70 years, who received a questionnaire between January and April 2008. By June 2008, 87% (3,253) of eligible women returned the questionnaire. The researchers found that a total of 1,543 patients (47%) reported pain in 1 or more areas, of which 13% reported severe pain, 39% reported moderate pain, and 48% reported light pain. Among women reporting severe pain, 77% experienced pain every day, whereas only 36% of women experiencing light pain had pain every day. Adjuvant radiation therapy, but not chemotherapy, increased the risk of reporting pain. Axillary lymph node dissection was associated with increased likelihood of pain or sensory disturbances, compared with sentinel lymph node dissection. “There was a significant association of age on reporting pain, where young age was associated with higher risk, especially for patients receiving breast-conserving surgery (BCS), the risk being highest for those women aged 18 to 39 years receiving BCS compared with women aged 60 to 69 years,” the authors wrote. A total of 58% of the patients reported sensory disturbances or discomfort, with the most frequently reported areas the axilla, followed by arm, breast area, and side of the body. A total of 306 patients (20%) with pain had contacted a physician within the prior 3 months for pain complaints in the surgical area. “Based on the results of our study together with previously reported findings, chronic pain after breast cancer surgery and adjuvant therapy may predominantly be characterised as a neuropathic pain state and probably related to intraoperative injury of the intercostal-brachial nerve,” the authors wrote. In accordance with these findings, preliminary observations with nerve-sparing techniques may suggest such approaches to reduce the risk of developing a chronic neuropathic pain state. However, such studies need to be larger and more detailed, taking all the different subgroups as studied in our investigation into consideration.” T SOURCE: JAMA E-mail this page to a friend or colleague! To print, use this version