| BackgroundBreast cancer is one of the most important malignant tumors,threatening women's life all over the world.In China,the incidence rate of breast cancer is increasing year by year,which has become the first reason for the death of young female cancer patients.Surgical treatment is the most important part of the comprehensive treatment of breast cancer.Controlling the postoperative acute pain can accelerate the long-term and short-term recovery of breast cancer.Poor postoperative acute pain control increased the risk of postoperative cardiovascular and cerebrovascular adverse events,inhibited the recovery of gastrointestinal function,delayed the recovery of postoperative motor function,reduced patient satisfaction,and increased the risk of long-term postoperative chronic pain.At present,the mechanism of pain is becoming clearer,and the drugs and methods to deal with postoperative acute pain is becoming more and more,but these advances have not led to a great improvement in postoperative pain.Poor postoperative pain treatment is still a worldwide problem.Pain is a subjective feeling with many factors.In the past 20 years,the effect of sleep on pain has attracted attention.An increasing number of studies have been found the reciprocal relationship between chronic pain and sleep.Chronic pain has been shown to disturb normal sleep.On the other hand,sleep problems aggravate existing chronic pain and induce new chronic pain.It has been verified that sleep deprivation and sleep fragmentation can reduce the threshold of pain and induce hyper-algesia in both healthy human and animal experiments.While there were few studies investigate the relationship between sleep and postoperative acute pain,but it has been reported that 30%-75%of breast cancer patients have different levels of sleep disorders before surgery.So it is clinically significant to discuss whether preoperative sleep problems affect the postoperative acute pain of breast cancer patients and the demand of analgesics.Chronic pain after breast surgery was firstly reported by wood at 1978,described as a sensation of numbness?burning or tingling on the operative side of the chest wall.armpit?upper arm and shoulder after breast cancer surgery.In 1984,the concept of post-operative pain syndrome(PMPS)was put forward by Granek,which is a kind of pain or abnormal sensation with neuropathic pain characteristics lasting for more than3 months caused by the injury of intercostal brachial nerve during the operation of breast cancer.It has been reported that the incidence of PMPS is about 25%-68%,while medicine treatment result is unsatisfactory.PMPS often cause anxiety and depression,affect daily life and social interaction,and increase the government's medical expenditure.In view of the relationship between sleep and chronic pain,as well as the prevalence of postoperative sleep disorders,there is no relevant report on the relationship between postoperative sleep and chronic pain in breast cancer patients.The purpose of this study was to explore the effect of sleep on acute and chronic pain after breast cancer surgery and the changes of some inflammatory factors,in order to provide new ideas and directions for the prevention and treatment of acute and chronic pain of breast cancer patients.This study included two parts:the first one was a prospective cohort study,investigating the effect of preoperative sleep quality on the postoperative acute pain and the requirement of analgesics;in addition,measuring the concentration of some inflammatory factors at different time;the second one was to observe and compare the postoperative sleep quality and the incidence of PMPS by following up participants completed the first part for 1 year in order to explore the relationship between sleep quality and chronic pain after breast cancer surgery.The purpose of this study is to explore the effect of sleep on acute and chronic pain after breast cancer surgery,in order to provide new ideas and directions for the prevention and treatment of acute and chronic pain after breast cancer surgery.Part ? The effect of preoperative sleep quality on acute postoperative pain in breast cancer patients and the changes of inflammatory factorsObjective The aim of this prospective cohort study was to assess the effect of preoperative sleep quality of breast cancer patients on acute postoperative pain and the analgesics consumption after unilateral modified radical mastectomy.Methods The Pittsburgh Sleep Quality Index questionnaire(PSQI)was used to assess the overall sleep status of women scheduled for unilateral modified radical mastectomy in the past month.Based on the responses,patients were allocated to good sleep group or poor sleep group.Postoperatively,acute pain was assessed using the Numerical Rating Score in the first 24 hours;in addition,the requirement of analgesics and the incidence of postoperative complications were recorded.The fasting venous blood samples were taken after entering the operation room,at the end of operation and 24 hours postoperatively.The serum concentrations of IL-1?,IL-6,IL-10 and TNF-? were measured by enzyme linked immunosorbent assay(ELISA).Results 108 breast surgery patients were enrolled.Based on the PSQI results,55(50.93%)patients were allocated to poor sleep group and 53(49.07%)to good sleep group.Pain scores were similar in the two groups at the end of surgery(P>0.05);however,poor sleep group reported higher postoperative pain scores than the good sleep group at 2h(P<0.005),6h(P<0.001),12h(P<0.001),24h(P<0.005)and 48h(P<0.005)postoperatively.The incidence of severe pain in the poor sleep group was higher than that in the good sleep group(26.9%vs.8%,P<0.05),and the ratio of participants who required rescued analgesics was greater in the poor sleep group(51.9%vs.22%,P<0.005).The levels of IL-6(20.4±4 vs.6.4±1.2)ng/L?TNF-?(9.2±3.2 vs.6.7±1.2)ng/L and IL-10(11.7±2.2 vs.5.6±1.3)in poor sleep group were higher than normal sleep group(all P<0.05),the levels of IL-6?TNF-? and IL-10 in the two groups increased gradually at the end of surgery and 24 hours after operation,and there were differences between the two groups and within the group(all P<0.05).The levels of IL-1 p had no difference between both groups before operation(11.4±1.7 vs.11.5±2.7)ng/L(P>0.05)and after operation(11.6±1.6 vs.11.7±2.7)ng/L,while the concentration of IL-1? in the poor sleep group was higher at 24 hours postoperative(39±4.6 vs.21.5±3.7)ng/L(P<0.05).In addition,patients in poor sleep group had more postoperative nausea and vomitting(27%vs.8%,P<0.05)and longer hospital stay(7.7±1.2 vs.8.7±1.3,P<0.05)dayConclusion In this study,breast cancer patients with poor preoperative sleep quality reported more severe postoperative pain,required more analgesics and had more postoperative complications and longer hospital stay.Part ? Poor preoperative sleep quality is a risk factor of post-mastectomy pain syndrome(PMPS)Objective This prospective cohort study sought to investigate the change of postoperative sleep quality,the incidence of PMPS and the quality of life of breast cancer patients with different preoperative sleep quality within one year after breast surgery to provide new direction for the prevention and treatment of PMPS.Methods All patients of two groups who completed the first part of the trial were followed up for one year after surgery,using the Pittsburgh Sleep Quality Index questionnaire(PSQI)to assess the sleep quality at the 1st?3rd?6th and 12th month postoperatively,counting up the incidence of PMPS at 3?6 and 12 months,calculating the overall incidence of PMPS at the whole year,evaluating the chronic pain characteristics and general health level one year after operation by SF-MPQ and SF-36,comparing the differences between groups in the following aspects:postoperative sleep quality?incidence of PMPS?the character of chronic pain and the general health level.Results 102 breast surgery patients were enrolled in this part.Finally,a total of 97 patients completed this part trail(48 participants in the normal sleep group and 49 participants in the poor sleep group).The PSQI scores at the 1st month after surgery were higher than that preoperative in both groups(the normal sleep group:8.11±2.08 vs.3.35±1.26,P<0.05;the poor sleep group:13.33±2.02 vs.8.21±2.68,P<0.05).The PSQI scores at the 3rd month postoperatively recovered to the preoperative level in the normal sleep group(3.65±1.67 vs.3.35±1.26)(P>0.05),while which in the poor sleep group were still higher than the preoperative level at the same time(10.36±2.21 vs.8.21±2.68)(P<0.05)and recovered to the preoperative level at the 6th month postoperatively(8.51±1.87 vs.8.21±2.68)(P>0.05).There was no difference in the incidence of PMPS between the two groups at the 3rd months postoperatively(24%vs.21%,P>0.05),but the incidence of PMPS in the poor sleep group was higher than that in the normal sleep group at the 6th month(49%vs.25%,P<0.05)and 12th month(33%vs.15%,P<0.05)postoperatively,the same was true for the overall incidence of PMPS in the whole year after surgery.In addition,the scores of pain characteristics in the poor sleep group were higher and the health scores at all aspects of SF-36 were lower than those in normal sleep group(P<0.05)Conclusion Breast cancer patients with poor preoperative sleep have more severe and longer duration of postoperative sleep disorder,higher incidence of PMPS,higher chronic pain score and lower level of health. |
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