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Persistent Post Mastectomy Pain

Posted 9/17/2013

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  Attention is finally being paid to the rather common problem (best guess is that one third of women post mastectomy experience it) of chronic pain after mastectomy. My personal experience of a mastectomy without reconstruction has, blessedly, not included pain although I still feel the stretch when my extend my arm fully over my head (and have felt that since the 1993 surgery) and occasionally feel brief muscle spasms, like a charley horse, in my chest.

  However, I surely have talked with many women who do live with one or another kind of pain or discomfort after a mastectomy. In my clinical experience, this is more common for women who have had reconstruction, but I am aware of having a very biased sample. Presumably, women who are content with their surgery come less often to my office while women who are unhappy come frequently.

  This article from The Journal of Pain is a study from the University of Pittsburgh and the Brigham Hospital in Boston. It suggests that there is often a large component of psychological distress among women who report persistent pain. It is, of course, hard to separate the chicken vs. the egg here, but I find that an interesting and disturbing finding. One has to be very careful not to blame the victim.

  Here is the abstract and a link to read more:

Persistent Postmastectomy Pain in Breast Cancer Survivors: Analysis of Clinical, Demographic, and Psychosocial Factors


Inna Belfer,*,x,** Kristin L. Schreiber,zz John R. Shaffer,x Helen Shnol,* Kayleigh Blaney,*
Alexandra Morando,* Danielle Englert,* Carol Greco,z Adam Brufsky,jj,**
Gretchen Ahrendt,y,** Henrik Kehlet,xx Robert R. Edwards,yy,zz
and Dana H. Bovbjergz,{,#,**

Abstract: Persistent postmastectomy pain (PPMP) is increasingly recognized as a major individual
and public health problem. Although previous studies have investigated surgical, medical, and
demographic risk factors, in this studywe aimed tomore clearly elucidate the relationship ofpsychosocial
factors to PPMP. Postmastectomy patients (611) were queried about pain location, severity, and burden
38.3 ± 35.4 months postoperatively. Validated questionnaires for depressive symptoms, anxiety, sleep,
perceived stress, emotional stability, somatization, and catastrophizingwere administered. Detailed surgical,
medical, and treatment information was abstracted from patients’ medical records. One third
(32.5%) of patients reported PPMP, defined as$3/10 pain severity in the breast, axilla, side, or arm,which
did not vary according to time since surgery. Multiple regression analysis revealed significant and independent
associations between PPMP and psychosocial factors, including catastrophizing, somatization,
anxiety, and sleep disturbance. Conversely, treatment-related factors including surgical type, axillary
node dissection, surgical complication, recurrence, tumor size, radiation, and chemotherapy were not
significantly associated with PPMP. These data confirm previous studies suggesting that PPMP is relatively
common and provide new evidence of significant associations between psychosocial characteristics
such as catastrophizing with PPMP, regardless of the surgical and medical treatment that patients
receive, which may lead to novel strategies in PPMP prevention and treatment.
Perspective: This cross-sectional cohort study of 611 postmastectomy patients investigated
severity, location, and frequency of pain a mean of 3.2 years after surgery. Significant associations
between pain severity and individual psychosocial attributes such as catastrophizing were found,
whereas demographic, surgical, medical, and treatment-related factors were not associated with
persistent pain.

www.jpain.org%20and%20www.sciencedirect.com

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