Severity of acute pain after breast surgery is associated with the likelihood of subsequently developing persistent pain.
OBJECTIVE
Persistent postsurgical pain (PPSP) after surgery for breast cancer has a prevalence of 20% to 52%. Neuroplastic changes may play a role in the aetiology of this pain. The principal objective of this study was to examine the relationship between acute pain after surgery for breast cancer and the likelihood of subsequently developing PPSP.


METHODS
Twenty-eight women undergoing surgery for breast cancer completed visual analogue scales for pain and anxiety, the McGill Pain Questionnaire (long form) and the Hospital Anxiety and Depression Scale. Analgesic requirements and adverse effects of analgesic therapy were noted. Quantitative sensory testing was carried out perioperatively using an electrical stimulus, and the sensation perception, pain perception, and pain tolerance thresholds were measured bilaterally at the T4 dermatomes and at the contralateral L5 dermatome. Patients with and without PPSP 3 months postoperatively were compared in terms of these parameters.


RESULTS
Eight participants (28.6%) reported PPSP. Those who subsequently developed PPSP reported greater pain scores on the McGill Pain Questionnaire 5 days postoperatively than those that did not (pain rating index, P=0.014; present pain intensity, P=0.032). None had sought medical attention for their persistent pain. Patients with and without PPSP were similar in terms of mental status (anxiety and depression), analgesic consumption, adverse effects of analgesic therapy, and changes on QST.


CONCLUSIONS
Patients who developed PPSP experienced pain of greater intensity on the fifth postoperative day than those that did not.
Hickey
Oonagh T
OT
Department of Anaesthesia, Cork University Hospital and University College Cork, Wilton, Ireland. oonaghhickey@yahoo.co.uk
Burke
Siun M
SM
Hafeez
Parvaiz
P
Mudrakouski
Aliaksandr L
AL
Hayes
Ivan D
ID
Shorten
George D
GD
D000328:Adult; D000368:Aged; D001007:Anxiety / Q000175:diagnosis / Q000523:psychology; D001940:Breast / Q000601:surgery*; D001943:Breast Neoplasms / Q000601:surgery*; D002908:Chronic Disease; D003863:Depression / Q000175:diagnosis / Q000523:psychology; D005260:Female; D006801:Humans; D008408:Mastectomy / Q000009:adverse effects*; D008875:Middle Aged; D010147:Pain Measurement; D017288:Pain Threshold; D010149:Postoperative Pain / Q000503:physiopathology* / Q000523:psychology; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires