Risk Factors Linked To Pain After Breast Cancer Surgery

Up to half of all women who undergo a lumpectomy or mastectomy feel pain weeks or months later near the breast, adjacent armpit and upper arm on the same side. It is often described as burning, throbbing, and/or a sharp pain.

In a study published in the September 2006 Journal of Pain, lead author Robert H. Dworkin, Ph.D., a University of Rochester Medical Center professor of anesthesiology, neurology, oncology and psychiatry, and international pain management expert, recommends that women facing breast-cancer surgery should be counseled beforehand to alleviate any distress they may have and improve coping skills. Results of the study suggest that a combination of analgesic drugs and counseling immediately after surgery might also help to prevent long-term problems, he said.

"Women with breast cancer have unique concerns and fears that may be connected to pain," Dworkin said. "And despite considerable changes over time in surgical approaches, these results are consistent with other studies."

Few prospective studies have identified the characteristics of patients who are most likely to develop chronic pain, which can diminish a woman's quality of life by leading to job loss or marriage stress, even if the cancer is successfully treated.

Dworkin's group evaluated and interviewed 95 women scheduled for a simple lumpectomy, a lumpectomy with axillary lymph node dissection or a mastectomy. Researchers asked the women to rate their pain (on a scale from zero to 10) two days after surgery, 10 days after surgery and at the three-month point.

They also collected demographic and clinical information on each patient, and conducted tests to assess their mental health. Nearly half of the women (48 percent) said they were experiencing surgery-related pain three months later. Women under age 50 were most likely to report it.

Data from the women who developed chronic pain was then compared to the women who did not report chronic pain. In addition to age, the women most likely to suffer debilitating chronic pain had more extensive surgery followed by radiation, and reported the most severe pain in the first week after their operation.

Researchers were surprised to find that a woman's anxiety before surgery did not emerge as a direct risk factor for chronic pain, as previous studies had shown that anxiety is clearly a risk factor for acute, post-operative pain.

Most pain stems from damage to the intercostal brachial nerve, which runs under the arm and rib cage. But many other triggers exist as well: scarring, post-operative radiation therapy, some chemotherapy drugs, and the unusual sensations often associated with phantom pain.

Pain is a difficult topic for people with cancer, Dworkin said.

"For some individuals acknowledging pain can be frightening because they think it might mean recurrence or metastasis," Dworkin said. "We've also found that it is difficult for people with cancer to characterize their pain and to report it to their doctors. They are concerned that talking about pain will distract the oncologist from focusing on other aspects of the treatment plan."Co-investigators from URMC were: Carl H. Andrus, M.D., clinical associate professor of surgery; Laura A. Hogan, palliative care service at Strong Memorial Hospital; and Ellen L. Poleshuck, Ph.D., assistant professor of psychiatry and obstetrics and gynecology.