Postmastectomy pain most troubling for breast cancer survivors

Persistent postmastectomy pain is rated by survivors as the most troubling symptom by women with breast cancer who undergo surgery. Surgery is part of the treatment for breast cancer for more than 40% of 200,000 US women with breast cancer every year.

Researchers from the University of Pittsburgh evaluated 611 women who had undergone total or partial mastectomy and were treated with chemotherapy, radiation, and/or hormone therapy. Their objective was to determine which factors—demographics, tumor size, pain severity, treatments, stress, and psychological factors—contribute to postmastectomy pain. Their study was published in The Journal of Pain (2013;14[10]:1185-1195).

According to the authors, previous research has provided little consensus regarding the most important determinants of pain following mastectomy. Earlier studies had small sample sizes and focused on just one group of variables. For this research, the authors used a much larger sample, which allowed them to study a large number of variables at the same time.

Results showed, in accordance with some previous research, that there was no evidence of linkage between the type of mastectomy performed, tumor size, or the occurrence of treatment side effects and the development of postmastectomy pain. However, psychosocial variables were found to be important predictors. Specifically, anxiety, depression, impaired sleep, somatization, and catastrophizing each were independently related to the development of persistent postmastectomy pain. “Psychological vulnerability may have the potential to worsen any pain experience,” stated the authors.

The researchers also suggested several factors that may contribute to individual variation in pain processing. These factors include differences in nociceptive sensitivity and descending modulation of pain. They stated that prospectively identifying those patients who are at highest risk and providing them with more intensive perioperative therapy, applying cognitive-behavioral therapy, or applying other distress-lowering measures or medications may help these women to avoid developing persistent pain after mastectomy.

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