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Published on: January 18, 2018
Chronic pain after major breast surgery: A retrospective cohort study
Victor Van Lishout1, Steffen Rex, Steffen Fieuws
1From the Department of Anaesthesiology, University Hospitals of the KU Leuven (VVL, SR, AT), Department of Cardiovascular Sciences (SR, AT), Department of Public Health and Primary Care, Leuven Biostatistics and Statistical Bioinformatics Centre (L-BioStat), KU Leuven (SF) and Departments of Obstetrics and Gynaecology, University Hospital of the KU Leuven, Leuven, Belgium (SH).
Background:
Breast surgery is a cornerstone in the treatment of breast cancer but can cause persistent or worsening pain lasting beyond 3 months. Perioperative risk factors for chronic pain remain an area of ongoing research.
Objective:
To assess the incidence of chronic pain following breast surgery and identify its associated factors.
Design:
A retrospective cohort study.
Setting:
A single high-volume tertiary medical centre.
Patients:
Women undergoing first-time unilateral breast surgery as part of breast cancer treatment, without pre-existing chronic pain, between January 2020 and September 2022.
Main Outcome Measures:
The incidence of chronic postoperative pain at 3 and 6 months, pain scores, perioperative and in-hospital analgesic use, and predictive factors related to anaesthetic and treatment modalities.
Methods:
Univariable and multivariable analysis of peri-operative data associated with chronic postoperative pain at 3 and 6 months. A multivariable model was constructed by stepwise selection of data.
Results:
Chronic pain was reported in 32% (95% confidence interval (CI), 28.8 to 35.4%) of patients at 3 months and in 39% (95% CI, 35.9 to 42.2%) at 6 months postoperatively. During postanaesthetic care, 31% of patients recorded a pain score above four on the numeric rating scale (NRS), while 3% reported a score above seven. On subsequent days, the mean pain score fell below one. The use of sufentanil and propofol during general anaesthesia was strongly associated with a lower incidence of pain at 3 months, odds ratio (OR) 0.548 (95% CI 0.381 to 0.788) P = 0.0012, as well as sentinel node biopsy, OR 0.520 (95% CI 0.274 to 0.988) P = 0.0459. Adjuvant radiotherapy, OR 3.294 (95% CI 1.610 to 6.741) P = 0.0011, and the presence of chronic pain at 3 months, OR 10.706 (95% CI 7.399 to 15.489) P < 0.0001, were the strongest predictors of persistent pain at 6 months. Mastectomy, OR 0.610 (95% CI 0.456 to 0.817) P = 0.0009, and age, OR 0.983 (95% CI 0.972 to 0.995) P = 0.0051, were significantly associated after model construction.
Conclusions:
Multiple factors are associated with chronic pain following breast surgery. While perioperative factors play a role, long-term treatment modalities also significantly influence its occurrence.
