title: Persistent breast pain following breast cancer surgery is associated with persistent sensory changes, pain interference, and functional impairments.
abstract: Interindividual variability exists in persistent breast pain following breast cancer surgery. Recently, we used growth mixture modeling to identify 3 subgroups of women (N = 398) with distinct persistent breast pain trajectories (ie, mild, moderate, severe) over 6 months following surgery. The purposes of this study were to identify demographic and clinical characteristics that differed among the breast pain classes and, using linear mixed effects modeling, to examine how changes over time and in sensitivity in the breast scar area, pain qualities, pain interference, and hand and arm function differed among these classes. Several demographic and clinical characteristics differentiated the breast pain classes. Of note, 60 to 80% of breast scar sites tested were much less sensitive than the unaffected breast. Significant group effects were observed for pain qualities and interference scores, such that, on average, women in the severe pain class reported higher scores than women in the moderate pain class. In addition, women in the moderate pain class reported higher scores than women in the mild pain class. Compared to women in the mild pain class, women in the severe pain class had significantly impaired grip strength, and women in the moderate and severe pain classes had impaired flexion and abduction.
  
  
  CONCLUSIONS
  Subgroups of women with persistent postsurgical breast pain differed primarily with respect to the severity rather than the nature or underlying mechanisms of breast pain. Pervasive sensory loss and the association between persistent breast pain and sustained interference with function suggest the need for long-term clinical follow-up.
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: 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: Redwood Regional Medical Group, Santa Rosa, California.
authors.forename: Charles
authors.initials: C
authors.lastname: Elboim
authors.affiliation: College of Dentistry, New York University, New York, New York.
authors.forename: Brian L
authors.initials: BL
authors.lastname: Schmidt
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 Medicine, University of California, San Francisco, California.
authors.forename: Gary
authors.initials: G
authors.lastname: Abrams
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*; D002921:Cicatrix / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology; D010147:Pain Measurement; D010149:Postoperative Pain / Q000503:physiopathology*
keywords: Breast pain; breast cancer surgery; chronic pain; grip strength; pain interference; pain qualities; persistent pain; range of motion; sensory changes