Chronic pain after breast surgery: incidence, associated factors and impact on quality of life, an observational prospective study
Background. Chronic pain after breast surgery (CPBS) has a disabling impact on postoperative health status. Mainly because of the lack of a clear definition, inconsistency does exist in the literature concerning both the actual incidence and the risk factors associated to CPBS. The aim of this prospective, observational study is to describe the incidence of and risk factors for CPBS, according to the definition provided by the IASP taskforce. The impact of CPBS on patients’ function and quality of life is also described.
Methods. Women aged 18+ undergoing oncological or reconstructive breast surgery from Jan until Apr 2018 at the Breast Unit of Careggi Hospital (Florence, Italy) were prospectively observed. Postoperative pain was measured at 0hrs, 3hrs, 6hrs, 12hrs, 24hrs, 48hrs, and 3 months (CPBS) after surgery. Preoperative, intraoperative, and postoperative factors were compared in CPBS and No-CPBS groups through multivariate logistic regression analysis.
Results. Among the 307 patients considered in this study, the incidence of CPBS was 28% [95%CI 23.1%-33.4%]. Results from the logistic regression analysis suggest that axillary surgery (OR [95%CI], 2.99 [1.13-7.87], p=0.03), preoperative use of pain medications (OR [95%CI], 2.04 [1.20-3.46], p=0.01), and higher dynamic NRS values at 6 hours postoperatively (OR [95%CI], 1.28 [1.05-1.55], p=0.01) were all independent predictors for CPBS.
Conclusions. Chronic pain after breast surgery is a frequent complication. In our cohort, long-term use of analgesics for pre-existing chronic pain, axillary surgery, and higher dynamic NRS values at 6 hours postoperatively were all factors associated with increased risk of developing CPBS. The possibility to early detect persistent pain, particularly in those patients at high risk for CPBS, might help physicians to more effectively prevent pain chronicisation.
Trial registration: clinicalTrials.gov registration NCT04309929
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Posted 12 Jan, 2021
Received 03 Jan, 2021
On 27 Dec, 2020
Invitations sent on 27 Dec, 2020
On 27 Dec, 2020
On 27 Dec, 2020
On 27 Dec, 2020
Received 30 Nov, 2020
On 30 Nov, 2020
Invitations sent on 24 Nov, 2020
On 24 Nov, 2020
On 23 Nov, 2020
On 23 Nov, 2020
On 23 Nov, 2020
On 22 Oct, 2020
Received 21 Oct, 2020
On 13 Oct, 2020
Invitations sent on 10 Oct, 2020
On 08 Oct, 2020
On 07 Oct, 2020
On 07 Oct, 2020
On 05 Sep, 2020
Received 04 Sep, 2020
On 17 Aug, 2020
On 17 Aug, 2020
Received 17 Aug, 2020
Invitations sent on 15 Aug, 2020
On 06 Aug, 2020
On 05 Aug, 2020
On 05 Aug, 2020
On 03 Aug, 2020
Chronic pain after breast surgery: incidence, associated factors and impact on quality of life, an observational prospective study
Posted 12 Jan, 2021
Received 03 Jan, 2021
On 27 Dec, 2020
Invitations sent on 27 Dec, 2020
On 27 Dec, 2020
On 27 Dec, 2020
On 27 Dec, 2020
Received 30 Nov, 2020
On 30 Nov, 2020
Invitations sent on 24 Nov, 2020
On 24 Nov, 2020
On 23 Nov, 2020
On 23 Nov, 2020
On 23 Nov, 2020
On 22 Oct, 2020
Received 21 Oct, 2020
On 13 Oct, 2020
Invitations sent on 10 Oct, 2020
On 08 Oct, 2020
On 07 Oct, 2020
On 07 Oct, 2020
On 05 Sep, 2020
Received 04 Sep, 2020
On 17 Aug, 2020
On 17 Aug, 2020
Received 17 Aug, 2020
Invitations sent on 15 Aug, 2020
On 06 Aug, 2020
On 05 Aug, 2020
On 05 Aug, 2020
On 03 Aug, 2020
Background. Chronic pain after breast surgery (CPBS) has a disabling impact on postoperative health status. Mainly because of the lack of a clear definition, inconsistency does exist in the literature concerning both the actual incidence and the risk factors associated to CPBS. The aim of this prospective, observational study is to describe the incidence of and risk factors for CPBS, according to the definition provided by the IASP taskforce. The impact of CPBS on patients’ function and quality of life is also described.
Methods. Women aged 18+ undergoing oncological or reconstructive breast surgery from Jan until Apr 2018 at the Breast Unit of Careggi Hospital (Florence, Italy) were prospectively observed. Postoperative pain was measured at 0hrs, 3hrs, 6hrs, 12hrs, 24hrs, 48hrs, and 3 months (CPBS) after surgery. Preoperative, intraoperative, and postoperative factors were compared in CPBS and No-CPBS groups through multivariate logistic regression analysis.
Results. Among the 307 patients considered in this study, the incidence of CPBS was 28% [95%CI 23.1%-33.4%]. Results from the logistic regression analysis suggest that axillary surgery (OR [95%CI], 2.99 [1.13-7.87], p=0.03), preoperative use of pain medications (OR [95%CI], 2.04 [1.20-3.46], p=0.01), and higher dynamic NRS values at 6 hours postoperatively (OR [95%CI], 1.28 [1.05-1.55], p=0.01) were all independent predictors for CPBS.
Conclusions. Chronic pain after breast surgery is a frequent complication. In our cohort, long-term use of analgesics for pre-existing chronic pain, axillary surgery, and higher dynamic NRS values at 6 hours postoperatively were all factors associated with increased risk of developing CPBS. The possibility to early detect persistent pain, particularly in those patients at high risk for CPBS, might help physicians to more effectively prevent pain chronicisation.
Trial registration: clinicalTrials.gov registration NCT04309929
Figure 1
Figure 2