Younger Breast Cancer Patients With Radiation and Node Dissection More Likely To Have Post-Op Pain

MedicalResearch.com Interview with:

Jason Busse PhD Department of Anesthesia Department of Clinical Epidemiology & Biostatistics McMaster University Hamilton, ON

Dr. Jason Busse

Jason Busse PhD
Department of Anesthesia
Department of Clinical Epidemiology & Biostatistics
McMaster University
Hamilton, ON

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Persistent pain after breast cancer surgery affects up to 60% of patients. Early identification of those at higher risk could help inform optimal management. We conducted a systematic review and meta-analysis of observational studies to explore factors associated with persistent pain among women who have undergone surgery for breast cancer. We found that development of persistent pain after breast cancer surgery was associated with younger age, radiotherapy, axillary lymph node dissection, greater acute postoperative pain and preoperative pain. Axillary lymph node dissection increases the absolute risk of persistent pain by 21%, and provides the only high yield target for a modifiable risk factor to prevent the development of persistent pain after breast cancer surgery.

MedicalResearch.com: What should readers take away from your report?

Response: Most trials to date have focused on pharmacologic approaches to reduce pre-operative or acute post-operative pain, in order to reduce persistent post-surgical pain. Results, however, have not been encouraging. Given that the absolute increase in chronic pain we found associated with preoperative pain (6% absolute risk increase; 95%CI 0% to 11%) or greater postoperative pain (3% more for every 1cm on a 10cm VAS; 95%CI 1% to 6%) is modest, any reduction in persistent pain achieved through pharmacologic reduction of perioperative pain will likely be obscured by the random error from all other determinants of long-term pain. In other words, it would require a very large (and thus implausible) reduction of perioperative pain to result in detectable effects in randomized trials examining the impact on chronic postoperative pain.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Future research should establish the association between overall comorbidity, radiotherapy dosage and persistent postsurgical pain, and determine whether axillary nerve-sparing techniques are effective for reducing chronic pain after breast surgery.

MedicalResearch.com: Is there anything else you would like to add?
Response:

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Li Wang et al. Predictors of persistent pain after breast cancer surgery: a systematic review and meta-analysis of observational studies. CMAJ, July 2016 DOI: 10.1503/cmaj.151276

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