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Multicenter Study
. 2014 Jun;18(3):242-53.
doi: 10.1016/j.ejon.2013.12.002. Epub 2014 Jan 29.

Identification of patient subgroups and risk factors for persistent arm/shoulder pain following breast cancer surgery

Christine Miaskowski  1 , Steven M Paul  2 , Bruce Cooper  2 , Claudia West  2 , Jon D Levine  3 , Charles Elboim  4 , Deborah Hamolsky  2 , Gary Abrams  3 , Judith Luce  3 , Anand Dhruva  3 , Dale J Langford  2 , John D Merriman  2 , Kord Kober  2 , Christina Baggott  2 , Heather Leutwyler  2 , Bradley E Aouizerat  5
Affiliations
Multicenter Study

Identification of patient subgroups and risk factors for persistent arm/shoulder pain following breast cancer surgery

Christine Miaskowski et al. Eur J Oncol Nurs. 2014 Jun.

Abstract

Purpose: In this prospective, longitudinal study, we extend our findings on persistent breast pain in patients (n = 398) following breast cancer surgery and evaluate the prevalence and characteristics of persistent pain in the arm/shoulder. In addition, differences in the severity of common symptoms and quality of life outcomes measured prior to surgery, among the arm pain classes, were evaluated.

Methods and sample: Patients were recruited from Breast Care Centers located in a Comprehensive Cancer Center, two public hospitals, and four community practices. Patients were assessed prior to and monthly for six months following breast cancer surgery.

Results: Using growth mixture modeling, patients were classified into no (41.6%), mild (23.6%), and moderate (34.8%) arm pain classes based on ratings of worst arm/shoulder pain. Compared to the no pain class, patients in the moderate pain class were significantly younger, had a higher body mass index, and were more likely to report preoperative breast pain and swelling in the affected breast. In addition, patients in the moderate pain class reported higher levels of depression, anxiety, and sleep disturbance than the no pain class.

Conclusions: Findings suggest that approximately 35% of women experience persistent levels of moderate arm/shoulder pain in the first six months following breast cancer surgery. Moderate arm/shoulder pain is associated with clinically meaningful decrements in functional status and quality of life.

Keywords: Arm pain; Breast cancer surgery; Chronic pain; Growth mixture modeling; Latent class analysis; Persistent postsurgical pain; Risk factors; Shoulder pain.

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Figures

Figure 1
Figure 1
Observed and estimated breast pain trajectories for patients in each of the latent classes.
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