Effect of axillary lymph node dissection on prevalence and intensity of chronic and phantom pain after breast cancer surgery.
Chronic pain after breast cancer surgery is a major problem and is expected to increase in the coming years because of an increased prevalence of breast cancer coupled with better survival. Axillary lymph node dissection (ALND) in patients with breast cancer is associated with nerve damage. The present study investigated the effect of ALND on the prevalence and intensity of chronic pain after breast cancer surgery. Furthermore, we studied the effect of chemotherapy and radiotherapy on chronic pain and the quality of life after breast cancer surgery. We analyzed 317 questionnaires of patients who underwent surgery for breast cancer between 2002 and 2004. In the first part, questions were asked concerning the prevalence of chronic pain, its intensity (visual analog scale), and phantom breast pain. The second part covered quality of life and included the EORTC QLQ-C30/BR-23. The prevalence of chronic pain after breast cancer surgery with ALND is double that without ALND (51% vs 23%). Chronic pain intensity and prevalence of phantom breast pain were not influenced by ALND. Chemotherapy and radiotherapy in interaction with ALND were associated with increased prevalence of chronic pain. The quality of life in patients was mainly affected by chronic pain and to a lesser extent by type of surgery.


CONCLUSIONS
Nerve injury is particularly efficient at producing central sensitization. ALND in conjunction with breast cancer surgery is associated with a doubled prevalence of chronic pain, which has not been described to date. ALND and nerve injury may play a major role in pain chronification after breast cancer surgery.
Steegers
Monique A
MA
Pain and Nociception Research Group, Department of Anaesthesiology, Pain, and Palliative Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Wolters
Bas
B
Evers
Andrea W
AW
Strobbe
Luc
L
Wilder-Smith
Oliver H
OH
D000368:Aged; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D002908:Chronic Disease; D004358:Drug Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D008197:Lymph Node Excision / Q000009:adverse effects; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D011183:Postoperative Complications / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy; D015995:Prevalence; D011446:Prospective Studies; D011788:Quality of Life; D011878:Radiotherapy; D011795:Surveys and Questionnaires