| Background Chronic post-operative pain of breast cancer is a kind of chronic pain which occurs after breast cancer surgery,lasting longer than normal breast tissue healing time(3 months),excluding pain caused by other diseases.Long term complications of breast cancer consist of limited mobility of the shoulder joint,lymphedema,pain,etc.Because of the longer survival time of patients with breast cancer,the quality of patients' lives after surgery have been brought into focus.Chronic pain following breast cancer surgery is a common clinical problem which has a serious negative impact on the life quality and psychological state of patients.Severe postoperative chronic pain may have a serious impact on daily life and work.If the patients suffered a long time,there would be an severe effect on the mental state which resulting anxiety,depression and other symptoms.According to foreign reports,the incidence of chronic pain following breast cancer surgery is about 25% to 60%.Age,radiotherapy,chemotherapy,endocrine therapy,BMI,anxiety and depression are the potential risk factors for chronic pain following breast cancer surgery.Because of the difference of follow-up time and evaluation criteria,the incidences of chronic pain after breast cancer surgery are inconsistent.There are many researches in this filed because of plenty of concerns over the chronic pain following breast cancer surgery.Conversely there are few studies in China,and the follow-up time was about half a year to one year after operation.There are few long-term follow-up of the chronic pain following breast cancer surgery.Lacking of long-term follow-up,it is necessary to follow these patients to find the epidemiological characteristics of the chronic post-operative pain and the potential related factors.Objective To study the epidemiological characteristics of chronic pain following breast cancer surgery,analyze the related factors,and provide the basis for postoperative rehabilitation and intervention of patients with breast cancer.Methods We enrolled 912 patients who were diagnosed with breast cancer and underwent surgery between January 2011 to March 2016.Patients who fit the definition of postoperative chronic pain were enrolled in the pain group and assessed with the DN-4 scale.Inclusion criteria:(1)All patients were diagnosed as breast cancer;(2)American Society of anesthesiologists(ASA)?~?,without serious medical complications;(3)Without cognitive impairment,informed of the disease diagnosis,and agreed to accept the investigation.Exclusion criteria:(1)Combined with other malignancies;(2)Bilateral breast cancer;(3)Breast cancer recurrence and distant organ metastasis;(4)Breast prosthesis implantation;(5)Combined with other diseases which may cause pain(such as chronic infection).The general information of patients were collected,such as height,weight,age,past history,BMI,contact information.The patients' tumor site,surgical procedure,axillary lymph node dissection,sentinel lymph node biopsy,chemotherapy,radiotherapy and endocrine therapy were recorded.Patients were followed up by telephone.Neuropathic pain was diagnosed by Douleur Neuropathique-4 scale.If scores higher than 4,it was considered as neuropathic pain.The location,nature,inducing or aggravating factors,interval time and onset of chronic pain were recorded.The patients were divided into painful group and non-painful group.The general information and treatment methods were statistical analyzed between the two groups.Results(1)The incidence of chronic pain following breast cancer surgery.A total of 912 patients with breast cancer who underwent surgical treatment were investigated.Due to telephone number missing and other reasons,91 cases were lost.821 cases were followed up actually.The age of the patients ranged from 22 to 77,with an average age of 49.2±10.4.There were 263 patients suffering chronic post-operative pain,and the incidence was 32%.In the painful group,33 patients underwent breast conserving surgery and sentinel lymph node biopsy,71 patients underwent mastectomy and sentinel lymph node biopsy,16 patients underwent breast conserving surgery and axillary lymph node dissection,143 patients underwent modified radical mastectomy.In the non-painful group,200 patients underwent breast conserving surgery and sentinel lymph node biopsy,116 patients underwent mastectomy and sentinel lymph node biopsy,23 patients underwent breast conserving surgery and axillary lymph node dissection,219 patients underwent modified radical mastectomy.According to the classification of the surgery methods,the incidence of chronic pain in patients with breast conserving surgery +sentinel lymph node biopsy was 14.2%(33/233),the incidence of chronic pain in patients with mastectomy + sentinel lymph node biopsy was 38.0%(71/187),the incidence of chronic pain in patients with breast conserving surgery + axillary lymph node dissection was 41.0%(16/39),the incidence of chronic pain in patients with modified radical mastectomy was 39.5%(143/362).(2)Distribution characteristics of chronic pain after breast cancer surgery.In the painful group,the main sites of pain were the chest wall accounting for 69.6%(183/263),axillary accounting for 48.3%(127/263)secondly,upper arm accounting for 29.7%(78/263)thirdly.The back and shoulder appeared in two cases.The main pain sites were also different because of the difference of surgical methods.In patients who underwent breast conserving surgery and sentinel lymph node biopsy,the main sites of pain were chest wall accounting for 81.8%(27/33),axillary fossa accounting for 21.2%(7/33)secondly.In the patients who underwent mastectomy and sentinel lymph node biopsy,the main sites of pain were chest wall accounting for 90.1%(64/71),axillary fossa accounting for 20.8%(16/77)secondly.In patients who underwent breast conserving surgery and axillary lymph node dissection,the main site of pain waere axillary fossa accounting for 68.7%(11/16),upper arm accounting for 31.3%(5/16)secondly,and chest wall accounting 25%(4/16)thirdly.In patients with modified radical mastectomy,the main sites of pain were axillary fossa accounting for 65.0%(93/143),the chest wall accounting for 61.5%(88/143),then the upper arm accounting for 50.3%(77/143).(3)Characteristics of chronic pain after breast cancer surgery.Most of the nature of pain were numbness(194 cases,73.8%),tingling(102 cases,38.8%).Jumping pain,swelling pain,tenderness and lightning pain accounted for 8.4%(22/263).According to the DN-4score,47 patients' scores were higher than 4,accounting for 17.9%(47/263),suggesting that about 17.9% of the patients in the pain group were highly suspected of suffering neuropathic pain.The onset time of pain ranged from a few days to a few weeks.(4)Influencing factors of postoperative chronic pain in patients with breast cancer.The patients' age,height,weight and BMI were analyzed.The P values were 0.903,0.818,0.532,0.539,without significant difference,between two groups.The surgical approach(breast conserving surgery or total resection),axillary lymph node dissection,chemotherapy,radiotherapy,endocrine therapy,Herceptin were analyzed.The P values were 0.000?0.000?0.663?0.323?0.138?0.913.There were significant differences between the two groups in surgical treatment and axillary lymph node dissection(P<0.0001).The logistic regression analysis was used to analyze the occurrence of two types of variables,axillary lymph node dissection and chronic postoperative chronic pain.The result suggested that both of them were the risk factors.Conclusion1.The incidence of chronic pain after breast cancer surgery is high,with an average of32%,which is worthy attention.Breast cancer has entered the era of precision medicine.Patients with breast cancer payed more and more attention to humanistic care,thus the postoperative chronic pain rehabilitation intervention research and application should be strengthened.2.The main site of pain was the chest wall,followed by axillary,and finally the upper arm,shoulder and back were very few.3.The nature of chronic pain was numbness,followed by tingling.According to the DN-4 score,17.9% of patients in painful group were considered with neuropathic pain.The overall incidence of neuropathic pain was 5.72%(47/821).4.The single factor analysis suggested that there were significant differences in the operation mode of the breast and the axillary operation mode between the painful group and the non-painful group.There was no significant difference in general information and adjuvant therapy between the two groups.The incidence of chronic pain in patients with breast conserving and sentinel lymph node biopsy was lower than patients with mastectomy ± axillary lymph node dissection. |
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