title: Persistent arm pain is distinct from persistent breast pain following breast cancer surgery.
abstract: Persistent pain following breast cancer surgery is well documented. However, it is not well characterized in terms of the anatomic site affected (ie, breast, arm). In 2 separate growth mixture modeling analyses, we identified subgroups of women (N = 398) with distinct breast pain and arm pain trajectories. The fact that these latent classes differed by anatomic site, types of tissue affected, and neural innervation patterns suggests the need for separate evaluations of these distinct persistent pain conditions. The purposes of this companion study were to identify demographic and clinical characteristics that differed between the 2 arm pain classes and determine if differences existed over time in sensitivity in the upper inner arm and axillary lymph node dissection sites, pain qualities, pain interference, and hand and arm function, as well as to compare findings with persistent breast pain. Higher occurrence rates for depression and lymphedema were found in the moderate arm pain class. Regardless of pain group membership, sensory loss was observed in the upper inner arm and axillary lymph node dissection site. Arm pain was described similarly to neuropathic pain and interfered with daily functioning. Persistent arm pain was associated with sustained impairments in shoulder mobility.
  
  
  CONCLUSIONS
  For persistent breast and arm pain, changes in sensation following breast cancer surgery were notable. Persistent arm pain was associated with sustained interference with daily functioning and upper body mobility impairments. Long-term management of persistent pain following breast cancer surgery is warranted to improve the quality of survivorship for these women.
authors.affiliation: School of Nursing, University of California, San Francisco, California.
authors.forename: Dale J
authors.initials: DJ
authors.lastname: Langford
authors.affiliation: School of Nursing, University of California, San Francisco, California.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Paul
authors.affiliation: School of Nursing, University of California, San Francisco, California.
authors.forename: Claudia
authors.initials: C
authors.lastname: West
authors.affiliation: School of Medicine, University of California, San Francisco, California.
authors.forename: Gary
authors.initials: G
authors.lastname: Abrams
authors.affiliation: Redwood Regional Medical Group, Santa Rosa, California.
authors.forename: Charles
authors.initials: C
authors.lastname: Elboim
authors.affiliation: School of Medicine, University of California, San Francisco, California.
authors.forename: Jon D
authors.initials: JD
authors.lastname: Levine
authors.affiliation: School of Nursing, University of California, San Francisco, California.
authors.forename: Deborah
authors.initials: D
authors.lastname: Hamolsky
authors.affiliation: School of Medicine, University of California, San Francisco, California.
authors.forename: Judith A
authors.initials: JA
authors.lastname: Luce
authors.affiliation: School of Nursing, University of California, San Francisco, California.
authors.forename: Kord M
authors.initials: KM
authors.lastname: Kober
authors.affiliation: School of Medicine, University of California, San Francisco, California.
authors.forename: John M
authors.initials: JM
authors.lastname: Neuhaus
authors.affiliation: School of Nursing, University of California, San Francisco, California.
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Cooper
authors.affiliation: School of Nursing, University of California, San Francisco, California; Institute for Human Genetics, University of California, San Francisco, California.
authors.forename: Bradley E
authors.initials: BE
authors.lastname: Aouizerat
authors.affiliation: School of Nursing, University of California, San Francisco, California. Electronic address: chris.miaskowski@nursing.ucsf.edu.
authors.forename: Christine
authors.initials: C
authors.lastname: Miaskowski
mesh_terms: D001132:Arm / Q000503:physiopathology*; D001940:Breast / Q000503:physiopathology* / Q000601:surgery; D001943:Breast Neoplasms / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D018737:Hand Strength / Q000502:physiology; D006801:Humans; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology; D010147:Pain Measurement; D010149:Postoperative Pain / Q000503:physiopathology*; D016059:Range of Motion, Articular / Q000502:physiology; D012782:Shoulder / Q000503:physiopathology; D013997:Time Factors
keywords: Arm pain; breast cancer surgery; chronic pain; grip strength; pain interference; pain qualities; persistent pain; range of motion; sensory changes