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A Quantitative Sensory Testing Paradigm to Obtain Measures of Pain Processing in Patients Undergoing Breast Cancer Surgery
Published on: January 18, 2018
Chronic Post-Surgical Pain at 3 Months After Breast Cancer Surgery: Incidence, Predictors, and an Internally
Abdelilah Ghannam1,2,3, Mohammed Anass Majbar1,4,5, Youssef Motiaa6
1Faculté de Médecine et de Pharmacie de Rabat, Université Mohammed V de Rabat, Impasse Souissi, Rabat 10100, Morocco.
Cancers
|August 13, 2026
Summary
Chronic post-surgical pain (CPSP) affects 39% of women post-breast cancer surgery in Morocco. Prediction models were developed, and regional anesthesia and ketamine showed potential benefits by reducing severe acute pain.
Area of Science:
- Oncology
- Pain Medicine
- Anesthesiology
Background:
- Chronic post-surgical pain (CPSP) is prevalent after breast cancer surgery, with limited data from the Middle East and North Africa (MENA) region.
- Understanding CPSP incidence and predictors is crucial for developing effective management strategies.
Purpose of the Study:
- To estimate the 3-month incidence of CPSP in a Moroccan cohort of women undergoing breast cancer surgery.
- To develop and validate prediction models for CPSP.
- To quantify the mediating effects of regional anesthesia and ketamine in preventing severe acute postoperative pain.
Main Methods:
- Prospective cohort study of 862 women undergoing breast cancer surgery.
- CPSP defined by Visual Analogue Scale (VAS) and Brief Pain Inventory (BPI) at 3 months.
- Two logistic regression models (preoperative and perioperative variables) developed and internally validated using bootstrap correction.
- Counterfactual mediation analysis used to assess mediated effects.
Main Results:
- CPSP incidence was 39.1%, with 22.6% being neuropathic-predominant.
- A perioperative prediction model (Model B) showed superior performance (AUC 0.694) compared to the preoperative model (Model A, AUC 0.58).
- Regional anesthesia and ketamine effects were significantly mediated through the prevention of severe acute pain (58.2% and 53.7%, respectively).
- Perioperative ketoprofen was independently associated with a reduced risk of pain chronification (aOR 0.66).
Conclusions:
- A significant proportion of women (39%) in this Moroccan cohort developed CPSP within three months of breast cancer surgery.
- Validated prediction models can aid in stratifying patient risk at different clinical decision points.
- Regional anesthesia and ketamine may reduce CPSP risk by mitigating severe acute postoperative pain, warranting further investigation.
- Perioperative ketoprofen demonstrates an independent protective effect against pain chronification.
