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Intensity and features of acute postoperative pain after mastectomy and breast-conserving surgery
Breast Cancer Researchvolume 12, Article number: P56 (2010)
Intensity of acute postoperative pain is a known risk factor for the development of chronic postsurgical pain; severe acute pain independently predicts chronic pain up to 1 year after breast cancer surgery . Most studies capture acute pain intensity using numerical or verbal rating scales (NRS/VRS). The objective of this study was to investigate intensity and characteristics of acute postoperative pain, using NRS and verbal descriptors, in the first week after breast surgery.
A prospective cohort study recruiting from four units in north Scotland. The sample was newly diagnosed women with histologically proven primary invasive or non-invasive breast cancer requiring mastectomy or wide local excision (WLE) with/without axillary clearance or sentinel lymph node biopsy. Pain was assessed in the first postoperative week: mean NRS scores at rest and movement; severe pain was defined as NRS >5 . Symptoms of ache, discomfort, pain, numbness and altered sensations were recorded.
Of 102 patients, mean age 60.5 years (SD 9.7), one-third (n = 34) had mastectomy and the remainder had WLE. All had axillary surgery: clearance/sample/sentinel lymph node biopsy. Mean NRS scores at rest after mastectomy and WLE, respectively, were: 1.25 (SD 0.4) vs. 1.15 (SD 0.36) (P = 0.23); scores on movement: 1.41 (SD 0.49) vs. 1.15 (SD 0.36) (P = 0.006). Forty-one per cent reported severe pain on movement after mastectomy vs.15% after WLE (P = 0.01). Twenty-two per cent of women reported altered sensations and numbness, mostly in the axilla region.
Although mean pain scores were low after surgery, almost one-quarter of patients reported postoperative numbness or altered sensations. Studies of postoperative pain should include assessment of pain character in addition to pain intensity.
Fecho K, Miller NR, Merritt SA, et al: Acute and persistent postoperative pain after breast surgery. Pain Med. 2009, 4: 708-715. 10.1111/j.1526-4637.2009.00611.x.