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Sixty-Five Percent Report Some Pain 1 Year After Surgery

Half of surveyed women with early-stage breast cancer reported mild pain at 12 months; 3.7 percent reported severe pain

January 16, 2014

Written By Marcia Frellick
Reviewed By Andrea V. Barrio, MD, FACS

Most women feel some level of pain 1 year after breast cancer surgery, Finnish researchers found. They hope their findings, published in the Journal of the American Medical Association, help inspire new ways of preventing and treating pain to improve quality of life after surgery.

Background

Results from previous studies show pain that persists after breast cancer surgery is common. Yet most of these studies were retrospective, meaning they depended on patients remembering how they felt in the past.

Researchers at the breast surgery unit of Helsinki University of Central Hospital (HUCH), Finland, wanted to study pain in a large, well-designed prospective study, following the same group of participants over time. The structure allowed them to ask women to rate pain just before their surgery and then again several months later.

This is especially important, Finnish researchers said, when studying factors such as pain before surgery, depression and anxiety. If women are asked to rate these factors based on their memories from a year earlier, results are less accurate because perceptions of pain change very much in that time.

Design

Researchers explored the level of, prevalence of, and factors associated with chronic pain in women with early-stage breast cancer after surgery and adjuvant treatment. Adjuvant therapy is treatment given after surgery, and may include chemotherapy and/or radiation therapy.

The 860 women who participated in the study were treated at HUCH between 2006 and 2010 and averaged 57 years of age.

Those eligible to take part:

  • were younger than age 75
  • had early-stage cancer in one breast
  • had lymph nodes removed from the armpit and either:
    •  breast-conserving surgery, removal of cancer and a small rim of healthy tissue, or
    • mastectomy, removal of the entire affected breast
  • did not receive neoadjuvant therapy, treatment given before surgery, and
  • did not have breast reconstruction

Before surgery, doctors took a medical history and gathered demographic data and information about emotional health from anxiety and depression surveys. Women were asked to rate pain at the site of the surgery (breast, armpit and arm) during the previous week. They indicated pain on a scale of 0 to 10 (0 = no pain; 1 – 3 = mild; 4 – 6 = moderate; ≥7 = severe). Twenty-four percent had chronic pain before the surgery.

Following surgery, nearly three-fourths (73 percent) of the women had radiation therapy and 57 percent received chemotherapy.

At 12 months after surgery the women were again asked to complete the pain survey, using the same scale to rate their discomfort.

Results

One year after surgery, 34.5 percent of the women said they had no pain, 49.7 percent reported mild pain, 12.1 percent moderate pain, and 3.7 percent severe pain.

Factors associated with pain 12 months after surgery were chronic pain prior to surgery, pain in the area to be operated on before surgery, removal of lymph nodes from the armpit, history of depression, and treatment with adjuvant chemotherapy and radiation therapy.

Limitation

The researchers acknowledge that this study did not assess, in detail, the type of persistent pain felt after 12 months. Follow-up is ongoing.

What This Means for You

If you feel some pain in the months following surgery for breast cancer, know that this study suggests this is common, even 1 year after surgery. It’s important to note that most of the women surveyed — 84 percent — reported no pain or mild pain. Still, any level of pain should be reported to your doctor.

To learn more about what you can do to reduce your risk of side effects after surgery, the causes of post-surgery breast pain and ways to treat it, download our podcast and presentation.

Meretoja, TJ, Leidenius, MHK, Tasmuth, T, Sipilä, R, Kalso, E. Pain at 12 months after surgery for breast cancer. Journal of the American Medical Association. 2014; 311(1):90-92

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