Risk Factors Associated With Post Mastectomy Pain Syndrome

Breast cancer,recognized as the common cancer among women,is one of the important causes of morbidity and mortality worldwide.The side effects associated with breast cancer treatment can occur in about 90% of patients.These complications may continue for months or years after treatment,having many implications on survivors' quality of life.Normally,surgery is the first choice of treatment for breast cancer.Post Mastectomy Pain Syndrome(PMPS)is occurrence of chronic pain following surgical treatment.The syndrome has a rather high prevalencereported up to 70% of women who underwent the surgery.PMPS is defined as a chronic pain that persists beyond the normal healing time of 3 months.The nature of the mentioned pain is commonly neuropathic with abnormal sensation in intercostal nerve distribution region of upper and lateral parts of thorax,axilla,and medial and posterior parts of arm and shoulder with the quality of exacerbated with movement.It is considered a neuropathic condition that arises after surgery for breast cancer.PMPS is a poorly understood chronic pain phenomenon,at present the strongest theory about the etiology and mechanism of this phenomenon is related to the neuralgia of intercostobrachial nerve caused by the damage to the nerves after mastectomy.The type of surgery,especially Complete Axillary Dissection(CAD),radiotherapy,chemotherapy,age,pre-and post operative breast pain size of tumor,all are considered as important risk factors.The objective of this article wasto review the etiopathogenesis,presentation,and risk factors related with the post-mastectomy pain syndrome.Objective: There are many studies on the long-term epidemiological follow-up studies of PMPS in the developed country.The risk factors of PMPS in China have not been fully understood and less related research is found.In this study,we selected patients who had been treated surgically for breast cancer of ASAI ~ III from January 2016-December 2016 in Jilin University Second Hospital,trying to summarize the risk factors associated with Post mastectomy pain syndrome.Provide guidance of the clinical treatment and intervention as well as prognosis of PMPS.Methods: Women of 18 to 75 years of age who had been treated surgically for breast cancer of ASAI ~ III from January 2016-December 2016 in Jilin University Second Hospital were selected,and the postoperative clinical and pathological diagnosis is breast cancer were included in the study.The medical records should include the tumor size,staging,axillary lymph node status,the surgical approach,intraoperative findings and complete pathological results.Patients with local or distant metastases,arthritis,or any other type of cancer or who had had surgery less than three months previously were excluded.The dependent variables(predictive variables)were: 1.patients' biological characteristics(body mass index [BMI],age dichotomized by over and under 50 years),2.positive prior history of any type of chronic pain(headache and/or dysmenorrhea).3.type of surgery(modified radical mastectomy or quadrantectomy with axillary lymphadenectomy and the number oflymph node dissected).Statistical Analysis: 1.quantitative data: calculate the mean and standard deviation(`X±SD),the comparison between groups using t test(including 95% confidence interval calculation),When the Heterogeneity of variance the rank sum test is used.2.count data: calculate using X2 test.3.analysis of influencing factors: logistic regression analysis,to determine the factors;statistical analysis was performed using SPSS 22.0.The relationship between PMPS and related variables was analyzed by logistic regression using two-class variables.Result: 1.PMPS epidemiological characteristics: In this study,a total of 203 cases of female breast cancer patients were studied,3 cases were disvisited.The age of the interview was 26-78 years,with an average age of 52.0 ± 10.7 years.Of the 200 patients,70(35%)had postoperative chronic pain.Each patient was followed by telephone.All patients surveyed see Table 3.1.For 70 patients,the pain occurred from 3 months to 12 months after surgery,the pain is not limited in only one part of the site,sometimes involving two and more.The most common side is the operation axilla(52 cases,74.3%),others were the same operation side of the chest wall(31 cases,44.3%),the same operation side of the upper arm(24 cases,34.3%).The pain was mostly numbness(36 cases,51.4%),followed by needle(29 cases,41.4%),electric shock(7 cases,10%),burning(5 cases,7.1%),Any other kind of pain(such as weakness,soreness pain)(4 cases,5.7%).2.PMPS risk factors analysis(1)Univariate analysis: Univariate analysis showed that there were statistically significant variables in PMPS and non-PMPS groups,which are age,number of lymph node dissections,and history of chronic pain.Statistical results.(see Table 3.2 and Table 3.3)(2)Logistic regression analysis: Three variables with single factor analysis were introduced into the logarithmic regression analysis of binary variables,and the standard of 0.05 was selected,and 0.1 was the rejection criterion.The variables of the regression equation are only age.It is shown that in this study,the impact of age on PMPS was greater and was an independent risk factor for PMPS.(see Table 3.4 and Figure 3.1)...