Older Women Least Likely to Have Continued Pain
After Breast Cancer Treatment
Researchers find women age 60 to 69 most immune
from pain found 2 to 3 years after treatment
Nov. 11, 2009 - Nearly 50 percent of women surveyed
indicate they experience pain symptoms 2 to 3 years after breast cancer
treatment, but older women and those who did not receive supplemental
radiation therapy are least likely to have pain, according to a study in
the November 11 issue of the Journal of the American Medical Association
(JAMA).
Persistent postsurgical pain has been shown to be
clinically relevant in many patients undergoing various common
operations, including breast cancer surgery. With breast cancer, the
pathogenic mechanisms are multiple, including nerve damage related to
surgical technique, according to background information in the article.
Different types of sensory disturbances (e.g.,
aftersensations, burning, or sensory loss) can occur after other
surgical procedures and may be an important part of the pain
characteristics in breast cancer.
"Pain has also been reported to be associated with
adjuvant (supplemental) therapy, such as chemotherapy and radiotherapy,"
the authors write.
Rune Gδrtner, M.D., of the University of
Copenhagen, Denmark, and colleagues examined the prevalence, associated
factors, and severity of chronic pain and sensory disturbances an
average of 26 months after surgery for breast cancer of 3,754 women,
ages 18 to 70 years, who received a questionnaire between January and
April 2008. By June 2008, 87 percent (3,253) of eligible women returned
the questionnaire.
The researchers found that a total of 1,543
patients (47 percent) reported pain in 1 or more areas, of which 13
percent reported severe pain, 39 percent reported moderate pain, and 48
percent reported light pain.
Among women reporting severe pain, 77 percent
experienced pain every day, whereas only 36 percent of women
experiencing light pain had pain every day.
Adjuvant radiation therapy, but not chemotherapy,
increased the risk of reporting pain.
Axillary lymph node dissection was associated with
increased likelihood of pain or sensory disturbances, compared with
sentinel lymph node dissection.
"There was a significant association of age on
reporting pain, where young age was associated with higher risk,
especially for patients receiving breast-conserving surgery (BCS), the
risk being highest for those women aged 18 to 39 years receiving BCS
compared with women aged 60 to 69 years," the authors write.
A total of 58 percent of the patients reported
sensory disturbances or discomfort, with the most frequently reported
areas the axilla (the underarm area), followed by arm, breast area and
side of the body.
A total of 306 patients (20 percent) with pain had
contacted a physician within the prior 3 months for pain complaints in
the surgical area.
"Based on the results of our study together with
previously reported findings, chronic pain after breast cancer surgery
and adjuvant therapy may predominantly be characterized as a neuropathic
pain state and probably related to intraoperative injury of the
intercostal-brachial nerve.
In accordance with these findings, preliminary
observations with nerve-sparing techniques may suggest such approaches
to reduce the risk of developing a chronic neuropathic pain state.
However, such studies need to be larger and more detailed, taking all
the different subgroups as studied in our investigation into
consideration," the researchers write.
Editorial: Evaluating Patients With Chronic Pain
After Breast Cancer Surgery
In an accompanying editorial, Loretta S. Loftus,
M.D., M.B.A., and Christine Laronga, M.D., of the H. Lee Moffitt Cancer
Center, Tampa, Florida, write regarding the importance of addressing
pain after surgery.
"Patients at high risk for the development of
postsurgical pain syndrome should be identified, should have therapy
initiated early, and the effects of early intervention should be
assessed. 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.
Thus, the findings reported by Gδrtner et al should
prove helpful in the search for achieving effective relief of pain after
breast cancer surgery."
Keep up with the latest news for senior citizens, baby
boomers
Nov. 11, 2009 - Nearly 50 percent of women surveyed
indicate they experience pain symptoms 2 to 3 years after breast cancer
treatment, but older women and those who did not receive supplemental
radiation therapy are least likely to have pain, according to a study in
the November 11 issue of the Journal of the American Medical Association
(JAMA).
