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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 10/2013

01-10-2013 | Breast Oncology

Incidence and Predictors of Neuropathic Pain Following Breast Surgery

Authors: Gregory C. Wilson, MD, Ralph C. Quillin III, MD, Dennis J. Hanseman, PhD, Jaime D. Lewis, MD, Michael J. Edwards, MD, Elizabeth A. Shaughnessy, MD, PhD

Published in: Annals of Surgical Oncology | Issue 10/2013

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Abstract

Purpose

Neuropathic pain (NPP) following breast surgery extends morbidity in the postoperative period. The incidence and etiology of postoperative NPP remains unclear and under-reported in literature. This study aims to define the incidence of neuropathic pain following breast surgery and to identify patient characteristics that are predictors for developing postoperative NPP.

Methods

Consecutive female patients undergoing breast resection surgery over a 5-year period (2008–2012) with 1-year minimum follow-up were included in this single-center study. Retrospective chart review was performed to identify patient specific characteristics including the development of post-operative NPP. Data was analyzed using univariate and multivariate logistic regression.

Results

A total of 470 patients were identified for study inclusion. The incidence of postoperative NPP was 14.7 % (69 of 470). Significant predictors for the development of postoperative NPP in the univariate analyses included history of diabetes mellitus, diabetic neuropathy, or fibromyalgia, concomitant axillary surgery, axillary node dissection, and taxane-based chemotherapy regimen. Multivariate analysis identified African American race [odds ratio (OR) = 1.78; 95 % CI = 1.01–3.17; p = 0.05), history of diabetes mellitus (OR = 1.98; 95 % CI = 1.0–3.74; p = 0.01) or fibromyalgia (OR = 2.75; 95 % CI = 1.13–6.69; p = 0.03), and taxane-based chemotherapy regimen (OR = 2.85; 95 % CI = 1.23–6.58; p = 0.01) as being independently associated with the development of postoperative NPP.

Conclusions

NPP is a significant risk following breast surgery. African American race, history of either diabetes mellitus or fibromyalgia, and treatment with taxane-based chemotherapy regimens are all associated with an increased risk of NPP.
Literature
1.
Stevens PE, Dibble SL, Miaskowski C. Prevalence, characteristics, and impact of postmastectomy pain syndrome: an investigation of women’s experiences. Pain. 1995;61:61–8.PubMedCrossRef
2.
Jensen MP, Chodroff MJ, Dworkin RH. The impact of neuropathic pain on health-related quality of life: review and implications. Neurology. 2007;68:1178–82.PubMedCrossRef
3.
Borsook D, Kussman BD, George E, Becerra LR, Burke DW. Surgically induced neuropathic pain: understanding the perioperative process. Ann Surg. 2013;257:403–12.PubMedCrossRef
4.
Smith WC, Bourne D, Squair J, Phillips DO, Chambers WA. A retrospective cohort study of post mastectomy pain syndrome. Pain. 1999;83:91–5.PubMedCrossRef
5.
Vilholm OJ, Cold S, Rasmussen L, Sindrup SH. The postmastectomy pain syndrome: an epidemiological study on the prevalence of chronic pain after surgery for breast cancer. Br J Cancer. 2008;99:604–10.PubMedCrossRef
6.
Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet. 2006;367:1618–25.PubMedCrossRef
7.
Wallace MS, Wallace AM, Lee J, Dobke MK. Pain after breast surgery: a survey of 282 women. Pain. 1996;66:195–205.PubMedCrossRef
8.
Giordano SH, Lin YL, Kuo YF, Hortobagyi GN, Goodwin JS. Decline in the use of anthracyclines for breast cancer. J Clin Oncol. 2012;30:2232–9.PubMedCrossRef
9.
Mo M, Erdelyi I, Szigeti-Buck K, Benbow JH, Ehrlich BE. Prevention of paclitaxel-induced peripheral neuropathy by lithium pretreatment. FASEB J. 2012;26:4696–709.PubMedCrossRef
10.
Wolf S, Barton D, Kottschade L, Grothey A, Loprinzi C. Chemotherapy-induced peripheral neuropathy: prevention and treatment strategies. Eur J Cancer. 2008;44:1507–15.PubMedCrossRef
11.
Baldwin RM, Owzar K, Zembutsu H, Chhibber A, Kubo M, Jiang C, et al. A genome-wide association study identifies novel loci for paclitaxel-induced sensory peripheral neuropathy in CALGB 40101. Clin Cancer Res. 2012;18:5099–109.PubMedCrossRef
12.
Vargas-Alarcon G, Alvarez-Leon E, Fragoso JM, Vargas A, Martinez A, Vallejo M, et al. A SCN9A gene-encoded dorsal root ganglia sodium channel polymorphism associated with severe fibromyalgia. BMC Musculoskelet Disord. 2012;13:23.PubMedCrossRef
13.
Martinez-Lavin M, Solano C. Dorsal root ganglia, sodium channels, and fibromyalgia sympathetic pain. Med Hypotheses. 2009;72:64–6.PubMedCrossRef
14.
Fassoulaki A, Triga A, Melemeni A, Sarantopoulos C. Multimodal analgesia with gabapentin and local anesthetics prevents acute and chronic pain after breast surgery for cancer. Anesth Analg. 2005;101:1427–32.PubMedCrossRef
15.
Fassoulaki A, Patris K, Sarantopoulos C, Hogan Q. The analgesic effect of gabapentin and mexiletine after breast surgery for cancer. Anesth Analg. 2002;95:985–91, table of contents.
16.
Kluding PM, Pasnoor M, Singh R, Jernigan S, Farmer K, Rucker J, et al. The effect of exercise on neuropathic symptoms, nerve function, and cutaneous innervation in people with diabetic peripheral neuropathy. J Diabetes Complications. 2012;26:424–9.PubMedCrossRef
17.
Reuben SS, Makari-Judson G, Lurie SD. Evaluation of efficacy of the perioperative administration of venlafaxine XR in the prevention of postmastectomy pain syndrome. J Pain Symptom Manage. 2004;27:133–9.PubMedCrossRef
18.
19.
Metadata
Title
Incidence and Predictors of Neuropathic Pain Following Breast Surgery
Authors
Gregory C. Wilson, MD
Ralph C. Quillin III, MD
Dennis J. Hanseman, PhD
Jaime D. Lewis, MD
Michael J. Edwards, MD
Elizabeth A. Shaughnessy, MD, PhD
Publication date
01-10-2013
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 10/2013
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-013-3156-6

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