Risk factors for chronic pain after breast cancer surgery include axillary lymph node dissection, younger age, and radiation therapy. Only axillary lymph node dissection is a high-yield target for a modifiable risk factor to prevent the development of persistent pain after breast cancer surgery.1

“Ten-year survival rates for breast cancer patients are now around 83%, but up to 60% of women who undergo surgery as part of cancer treatment, may develop chronic pain,” said Jason Busse, DC, PhD, an assistant professor of anesthesia and a researcher with the Michael G. DeGroote Institute for Pain Research and Care at the Michael G. DeGroote School of Medicine of McMaster University in Hamilton, Ontario, Canada, and senior author of the study.

This systematic review analyzed 30 observational studies that involved 20,000 women undergoing surgery for breast cancer. Analysis of this data suggested that disruption of sensory nerves in the axilla as lymph nodes are removed is associated with the development of chronic pain.

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“We cannot be certain that efforts to spare nerves during axillary surgery for breast cancer will prevent development of chronic pain,” Busse explained. “Although we found a 21% increase in risk for chronic postsurgical pain associated with axillary node surgery, nerve sparing may not always be possible, and when possible may not reduce the risk of chronic pain as much as the current evidence suggests.”

“Current standards in axillary surgery have already undergone a significant shift towards sentinel node biopsy, which lessens all potential complications for many patients,” said coauthor Susan Reid, MD, also of McMaster University. She stated that changes are being made around the world to change treatment.

This study was not funded by external sources.


1. Wang L, Guyatt GH, Kennedy SA, et al. Predictors of persistent pain after breast cancer surgery: a systematic review and meta-analysis of observational studies. CMAJ. 2016 Jul 11. doi:10.1503/cmaj.151276. [Epub ahead of print]