Nearly half of breast cancer survivors are plagued by persistent pain years after cancer surgery, Danish researchers found.
Pain two to three years later was most common for younger women and those who had axillary lymph node dissection, Dr. Rune Gärtner of the University of Copenhagen and colleagues reported. Their study appeared in the Nov. 11 Journal of the American Medical Association.
While prior studies have also supported a chronic pain rate of about 50 percent after breast cancer resection, identifying high-risk patients is an important advance, according to an accompanying editorial.
Dr. Loretta Loftus and Dr. Christine Laronga, both of the H. Lee Moffitt Cancer Center in Tampa, Fla., wrote that recognizing the predictors may help doctors start therapy ealier.
"Management requires a multidisciplinary approach that includes evaluation by surgeons, medical oncologists, radiation oncologists, pain management specialists, psychologists and psychiatrists, social workers, and experts in rehabilitation medicine," they said.
Although sentinel node dissection has reduced pain complaints after surgery, attention should focus on nerve-sparing techniques in particular, Gärtner's group added.
Postsurgical pain can stem from nerve damage during the operation, or from compression injury to certain nerves that can accompany lymphedema. The cause can even be a second primary tumor the editorialists noted.
Gärtner's group conducted a study of all Danish women who received breast cancer surgery and adjuvant therapy, if indicated, from 2005 through 2006.
What they found was that of the 3,754 women age 18 to 70 years who particpiated in the study, 47 percent of the patients reported pain in at least one area of their body. Among them, 13 percent had severe pain, with a score of at least 8 on the 10-point scale. For them, daily pain was the norm.
Another 39 percent of women who reported pain said it was of moderate severity with a score of 4 to 7 points on the same scale. But overall, only about a quarter of the women with pain sought any treatment for it.
The most common site of pain was the breast area, followed by the armpit, arm and side of the body. Interestingly, those who were younger seemed to have a higher chance of experiencing pain, as did those who underwent radiotherapy.
Sensory disturbances -- such as allodynia, aftersensations, burning, or sensory loss -- also appeared linked to chronic pain.
Further study is needed to determine how pain and sensory disturbances will develop or ease over time because the Danish study included only a single point, the researchers noted.