title: Pain and inflammation in women with early-stage breast cancer prior to induction of chemotherapy.
abstract: BACKGROUND
  Pain is a commonly experienced and distressing symptom in women with breast cancer (BCA), and recent evidence suggests that immune activation may be associated with pain and other co-occurring symptoms. However, no studies to date have explored the relationships among perceived pain and biomarkers of inflammation in women with early-stage BCA during the initial course of treatment.
  
  
  OBJECTIVE
  The purpose of this research study was to examine the relationships among pro- and anti-inflammatory biomarkers and the presence of pain and other symptoms (anxiety, depression, fatigue, and sleep disorder) prior to induction of chemotherapy.
  
  
  METHODS
  This was a secondary analysis of data that measured perceived symptoms, including the presence of pain and pain interference, and plasma levels of pro- and anti-inflammatory cytokines and C-reactive protein (CRP) in women with early-stage BCA (N = 32) at 1 month postsurgery but prior to induction of chemotherapy.
  
  
  RESULTS
  Women experiencing pain had significantly higher levels of CRP (p < .01), interleukin (IL) 13 (p < .02), and IL-7 (p < .02) and more pain interference (p < .01), depression (p < .01), and sleep disturbance (p < .01) compared to women reporting no pain.
  
  
  CONCLUSIONS
  The presence of pain during the initial course of treatment in women with early-stage BCA was associated with significantly higher levels of CRP, IL-7, and IL-13, suggesting a potential role of immune activation in perceived pain. Further research to examine the precise effects of these biological factors in modulating pain is needed. Perceived pain was also associated with multiple co-occurring symptoms, and this finding has important implications for symptom management.
authors.affiliation: Department of Adult Health and Nursing Systems, Virginia Commonwealth University School of Nursing, Richmond, VA 23298, USA. astarkweathe@vcu.edu
authors.forename: Angela R
authors.initials: AR
authors.lastname: Starkweather
authors.forename: Debra E
authors.initials: DE
authors.lastname: Lyon
authors.forename: Christine M
authors.initials: CM
authors.lastname: Schubert
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000503:physiopathology*; D008875:Middle Aged; D010147:Pain Measurement
chemical_list: D000970:Antineoplastic Agents
references.citation: Neuroreport. 2004 Dec 22;15(18):2807-11
references.pmid: 15597059
references.citation: Psychosom Med. 2002 Jul-Aug;64(4):604-11
references.pmid: 12140350
references.citation: Lancet Oncol. 2008 Aug;9(8):777-85
references.pmid: 18672213
references.citation: Brain Behav Immun. 2008 Nov;22(8):1197-200
references.pmid: 18617366
references.citation: J Pain. 2009 Nov;10(11):1146-50
references.pmid: 19595634
references.citation: Pain. 2008 Sep 30;139(1):15-27
references.pmid: 18396374
references.citation: Nat Rev Neurosci. 2006 Oct;7(10):797-809
references.pmid: 16988655
references.citation: Cancer Nurs. 2007 Sep-Oct;30(5):354-61
references.pmid: 17876181
references.citation: Brain Res Rev. 2007 Nov;56(1):148-69
references.pmid: 17706291
references.citation: BMC Cancer. 2008 Nov 11;8:330
references.pmid: 19014435
references.citation: Arthritis Rheum. 2009 Aug 15;61(8):1018-24
references.pmid: 19644894
references.citation: Cell Immunol. 2008 Mar-Apr;252(1-2):146-54
references.pmid: 18279847
references.citation: Cancer. 1999 Mar 1;85(5):1186-96
references.pmid: 10091805
references.citation: Cancer. 2003 Jun 1;97(11):2919-25
references.pmid: 12767108
references.citation: J Natl Cancer Inst Monogr. 2004;(32):76-8
references.pmid: 15263044
references.citation: Acta Anaesthesiol Scand. 2001 Oct;45(9):1067-75
references.pmid: 11683654
references.citation: Nurs Res Pract. 2010;2010:281531
references.pmid: 21994811
references.citation: Autoimmunity. 2008 Apr;41(3):230-8
references.pmid: 18365837
references.citation: Nurs Res. 2008 Jan-Feb;57(1):51-8
references.pmid: 18091292
references.citation: Breast Cancer Res Treat. 2003 Jul;80(1):39-48
references.pmid: 12889597
references.citation: Handb Clin Neurol. 2006;81:231-48
references.pmid: 18808839
references.citation: Pain. 2007 Dec 5;132(3):312-320
references.pmid: 17916403
references.citation: Oncol Nurs Forum. 2006 Sep 01;33(5):E79-89
references.pmid: 16955115
references.citation: CA Cancer J Clin. 2010 Sep-Oct;60(5):277-300
references.pmid: 20610543
references.citation: Sleep Med Rev. 2004 Jun;8(3):199-212
references.pmid: 15144962
references.citation: Clin Cancer Res. 2006 May 1;12(9):2759-66
references.pmid: 16675568
references.citation: J Nurs Scholarsh. 2007;39(1):61-7
references.pmid: 17393967
references.citation: Nat Rev Cancer. 2008 Nov;8(11):887-99
references.pmid: 18846100
references.citation: Disabil Rehabil. 2004 Jan 21;26(2):78-84
references.pmid: 14668143
references.citation: Curr Rheumatol Rep. 2007 Dec;9(6):503-10
references.pmid: 18177605
references.citation: Clin Cancer Res. 2009 Sep 1;15(17):5534-40
references.pmid: 19706826
references.citation: Int Anesthesiol Clin. 2007 Spring;45(2):27-37
references.pmid: 17426506
references.citation: Health Qual Life Outcomes. 2003 Aug 01;1:29
references.pmid: 12914662
references.citation: Neurosci Lett. 2006 Aug 14;404(1-2):154-8
references.pmid: 16777324
references.citation: Am J Respir Crit Care Med. 2003 May 1;167(9):1181-5
references.pmid: 12615621
references.citation: J Pain. 2008 Feb;9(2):122-45
references.pmid: 18088561
references.citation: Pers Individ Dif. 2007;42(3):419-429
references.pmid: 19011695
references.citation: Oncol Nurs Forum. 2006 Jan 01;33(1):E18-26
references.pmid: 16470230
references.citation: Am J Obstet Gynecol. 2004 Apr;190(4):1063-9
references.pmid: 15118643
references.citation: J Neuroimmunol. 2008 Mar;195(1-2):157-63
references.pmid: 18325600