title: Classification of and risk factors for estrogen deprivation pain syndromes related to aromatase inhibitor treatments in women with breast cancer: a prospective multicenter cohort study.
abstract: Aromatase inhibitors (AIs) are the first-line treatment in women with breast cancer for total estrogen depletion. Half the treated women may develop pain, and this condition may therefore be seen as a clinical model of pain related to estrogen deprivation. In this prospective multicenter study, we classified AI-related pain syndromes and identified their predictors. A 1-year, prospective, multicenter cohort study, with 6 visits, was carried out on 135 women with early-stage breast cancer and no pain at the start of AI treatment. At initial assessment, we investigated clinical (demographic and psychosocial, cancer characteristics and treatment, sleep, quality of life), biological (sex hormones, vitamin D, bone biomarkers, oxidative stress, immunologic and inflammatory markers), environmental, and genetic (polymorphism for pain mechanisms) risk factors for pain. During 1 year of follow-up, 77 women (57%) developed pain, leading to AI discontinuation in 12 cases. Five pain syndromes were identified: joint pain (36%), diffuse pain (22%), tendinitis (22%), neuropathic pain (9%), and mixed pain (11%), which are mostly persistent (57%), with diffuse and joint pains the most intense. Risk factors for the development of pain included higher levels of anxiety and impaired quality of life at the initial assessment, whereas cancer characteristics, genetic background, inflammation, and immunologic and hormonal status at baseline were not significant predictors.
  
  
  CONCLUSIONS
  This article presents a classification of AI-related pain syndromes induced by estrogen deprivation that were previously described as arthralgia, but not as neuropathic, diffuse, and mixed pain. This estrogen deprivation-related condition represents a clinical model of pain, and our study identified mostly psychological risk factors for pain development.
authors.affiliation: Pain Clinic, Saint Antoine Hospital, Paris, France.
authors.forename: Francoise
authors.initials: F
authors.lastname: Laroche
authors.affiliation: Biostatistics, Hôtel Dieu Hospital, Paris, France.
authors.forename: Joël
authors.initials: J
authors.lastname: Coste
authors.affiliation: Pain Clinic and Internal Medicine Department, Hôtel Dieu Hospital, Paris Descartes University, Paris, France.
authors.forename: Terkia
authors.initials: T
authors.lastname: Medkour
authors.affiliation: Medical Oncology Department, Institut Curie, Paris, France.
authors.forename: Paul Henri
authors.initials: PH
authors.lastname: Cottu
authors.affiliation: Medical Oncology Department, Institut Curie, Paris, France.
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Pierga
authors.affiliation: Oncology Department, Tenon Hospital, Paris, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Lotz
authors.affiliation: Oncology Department, Tenon Hospital, Paris, France.
authors.forename: Karine
authors.initials: K
authors.lastname: Beerblock
authors.affiliation: Oncology Department, Saint Antoine Hospital, Paris, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Tournigand
authors.affiliation: Pharmacology Department, Hôtel Dieu Hospital, Paris, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Declèves
authors.affiliation: Molecular Oncology, APHP and Paris-Diderot University, Saint Louis Hospital, Paris, France.
authors.forename: Patricia
authors.initials: P
authors.lastname: de Cremoux
authors.affiliation: INSERM U 987, Paris, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Bouhassira
authors.affiliation: Pain Clinic and Internal Medicine Department, Hôtel Dieu Hospital, Paris Descartes University, Paris, France; INSERM U 987, Paris, France. Electronic address: serge.perrot1@gmail.com.
authors.forename: Serge
authors.initials: S
authors.lastname: Perrot
mesh_terms: D000368:Aged; D000700:Analgesics / Q000627:therapeutic use; D047072:Aromatase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D018771:Arthralgia / Q000139:chemically induced / Q000175:diagnosis / Q000503:physiopathology; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000503:physiopathology; D004967:Estrogens; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D009437:Neuralgia / Q000139:chemically induced / Q000175:diagnosis / Q000503:physiopathology; D010146:Pain / Q000139:chemically induced* / Q000175:diagnosis / Q000503:physiopathology; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D013577:Syndrome; D052256:Tendinopathy / Q000139:chemically induced / Q000175:diagnosis / Q000503:physiopathology
chemical_list: D000700:Analgesics; D047072:Aromatase Inhibitors; D004967:Estrogens
keywords: Breast cancer; aromatase inhibitors; arthritis; estrogen deprivation; pain